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HEALTH 


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'DIACxNOSIS  OF 
JN'^rAL  INFECTION 
5YSTEMIC  DISEASES 


SINCLAIR  TOUSEY 


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Coluinliia  ^nibers^itp 

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College  of  ^Ijpgicians:  anb  burgeons! 


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Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

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ROENTGENOGRAPHIC 

DIAGNOSIS  OF 

DENTAL  INFECTION 

IN  SYSTEMIC  DISEASES 


ROENTGENOGRAPHIC 

DIAGNOSIS  OF 

DENTAL  INFECTION 

IN  SYSTEMIC  DISEASES 

BY 

SINCLAIR  TOUSEY.  A-M-.  M-D- 

CONSULTING  SURGEON,  ST   BARTHOLOMEWS  CLINIC,  NEW  YORK 


NEW  YORK 

PAUL  B.  HOEBER 

1916 


Copyright,  1916, 
By  Paul  B.  Hoeber 

Published  July,  1916 


Printed  in  the  United  States  of  Amea'ca 


PREFACE 

The  author  has  for  many  years  been  called  upon 
to  act  in  the  capacity  of  adviser  to  dentists  and 
physicians,  not  only  as  to  diagnosis  but  also  for 
treatment  and  prognosis.  The  advice  in  this 
book  regarding  treatment  is  not  intended  as  a 
guide  to  the  practice  of  dentistry  and  oral  sur- 
gery, but  it  is  hoped  that  it  may  aid  the  physician 
and  the  dentist  to  decide  when  an  infected  tooth 
should  be  extracted  and  when  it  can  be  cured  and 
remain  a  safe  and  useful  member. 

This  volume  is  an  elaboration  of  articles  on  the 
same  subject  read  before  the  Roentgen  Ray  Asso- 
ciation of  Greater  New  York,  Jan.  27,  1916;  the 
Bronx  County  Dental  Society,  Feb.  28,  1916;  the 
New  York  State  Dental  Society,  May  13,  1916; 
and  the  Medical  Association  of  Greater  New 
York,  May  15,  1916. 

Sinclair  Tousey. 
New  York, 

July  3,  1916. 


CONTENTS 


PAGE 


I.     Introduction 9 

II.     Infections  of  the   Teeth   and   Pneumatic 

Sinuses  and  Their  X-Ray  Diagnosis       .     10 

III.  Conditions  from  Which  Alveolar  Abscess 

and  Pyorrhea  Alveolaris  Must  Be  Dif- 
ferentiated      29 

IV.  Recent      Bacteriological      and      Clinical 

Studies 36 

V.  Lesions  and  Symptoms  Secondary  to  Infec- 
tion Connected  with  the  Teeth  or  the 
Pneumatic  Sinuses  op  the  Face  ...     40 

VI.     General  Conclusions 70 

Author's    Other    Publications    upon    the 

X-Ray  in  Dentistry 71 

Index 73 


ROENTGENOGRAPHIC   DIAG- 
NOSIS OF  DENTAL  INFEC- 
TION IN  SYSTEMIC 
DISEASES 

CHAPTER  I 

IJSTTKODUCTION 

^'Tlie  widest  publicity  should  be  given  to  the 
fact  that  greatly  varying  and  sometimes  serious 
or  fatal  systemic  diseases  and  those  affecting  re- 
mote organs  are  often  due  to  infection  connected 
with  the  teeth  or  with  the  pneumatic  sinuses  of 
the  face.  The  infected  foci  are  discoverable 
by  the  x-trjb.  Some  of  these  cases  are  cured 
by  treatment  of  the  oral  lesion  and  some  require 
also  autogenous  vaccination  with  a  bacterial  cul- 
ture from  the  pus  in  the  oral  lesion."  These  are 
the  words  of  an  eminent  jurist  whose  wife  has  been 
dragged  back  from  the  verge  of  the  grave  through 
the  discovery  by  the  :r-rays  of  the  foci  of  infec- 
tion in  connection  with  the  teeth.  Pernicious 
anemia  and  general  spinal  sclerosis  were  threaten- 
ing to  destroy  life.  The  judge's  remark  is  the 
occasion  for  these  pages. 

9 


10     ROBNTGENOGRAPHIC  DIAGNOSIS 


CHAPTER  II 

INFECTIOlSrS   OF    THE    TEETH    AND   PNEUMATIC    SINUSES 
AND  THEIE   X-EAY  DIAGNOSIS 

Alveolar  Abscess. — This  lesion  sometimes  de- 
velops insidiously  and  without  local  symptoms, 
and  these  are  the  most  dangerous  cases  because 
unrecognized  and  untreated.  Other  cases  pursue 
a  perfectly  frank  and  recognizable  course  as  fol- 
lows :  There  is  toothache  followed  by  a  painful 
swelling  of  the  jaw.  These  cases  naturally  seek 
relief  at  the  hands  of  the  dentist,  but  if  they  are 
neglected  an  abscess  forms  in  the  jaw  bone  sur- 
rounding the  apex  of  the  root,  denuding  the  latter 
and  sometimes  considerably  eroding  it.  In  some 
cases  there  is  more  or  less  necrosis  of  the  jaw.  All 
these  conditions  are  clearly  shown  with  almost 
microscopic  detail  in  a  radiograph.  The  usual 
treatment  of  a  fully  developed  alveolar  abscess  is 
by  opening  the  pulp  chamber  of  the  tooth,  remov- 
ing the  dead  or  dying  nerve,  draining  the  abscess 
cavity  through  the  root-canal,  enlarging  the  apical 
foramen  if  necessary  and  applying  repeated 
dressings  through  the  root-canal,  and  finally  fill- 
ing the  latter  with  a  nonabsorbent  material. 
Worse  cases  require  also  amputation  of  the  apex 


OF  DENTAL  INFECTION 


11 


of  the  root.  Figure  1  shows  a  case  cured  by  such 
an  operation.  Still  others  require  extraction  of 
the  tooth  with  or  without  curettage  of  a  necrotic 
area  of  bone. 

The  origin  of  an  alveolar  abscess  is  as  follows : 
The  pulp  or  ' '  nerve  "  of  a  tooth  is  richly  supplied 
with  blood-vessels  and  nerves.  It  completely  fills 
a  cavity  with  unyielding  walls  which  has  a  tiny 
opening  called  the 
apical  foramen. 
The  latter  is  occu- 
pied by  what  may 
be  called  the  stem 
of  the  nerve  which 
practically  stop- 
pers the  opening. 
The  pulp  may  be- 
come inflamed 
from  any  cause 
such  as  exposure 
to  cold,  a  neglected 

carious  cavity  in  the  tooth  substance  or  some 
other  cause.  The  rigid  walls  of  the  pulp-cham- 
ber prevent  any  expansion  of  the  inflamed  and 
congested  mass  of  ^' nerve"  or  pulp.  The  effect 
is  the  same  as  if  an  inflamed  and  congested  mass 
of  exquisitely  sensitive  living  tissue  were  forcibly 
compressed  into  a  space  only  half  large  enough  to 
contain  it.    An  analogy  from  general  surgery  is 


Figure    1. 


12     KOENTGENOGEAPHIC  DIAGNOSIS 

found  in  the  subperiosteal  suppuration  commonly 
known  as  bone  felon,  in  which  it  is  imperatively 
necessary  to  relieve  tension  by  an  incision  through 
the  periosteum. 

Attention  to  the  carious  cavity,  counterirritant 


Figure  2.  Figure  3. 

applications  to  the  gums  and  an  ice  bag  to  the 
cheek  may  relieve  the  congestion  and  the  pulp  may 
return  to  a  normal  condition. 

Other  cases  may  not  have  been  properly  treated 
or  the  congestion  may  have  been  so  severe  as  not 
to  yield  to  treatment.  The  inflamed  pulp  becomes 
strangulated  and  we  have  the  condition  known  as 
a  ^' dying  nerve."  The  dentist's  treatment  at  this 
stage  consists  in  drilling  into  the  pulp-chamber 
and  removing  the  nerve.  A  local  anesthetic 
makes  the  drilling  perfectly  endurable  and  the 
same  application  is  successful  in  anesthetizing  the 


OF  DENTAL  INFECTION 


13 


''nerve."  This  process  has  many  advantages 
over  the  old  method  of  hastening  the  deatli  of  the 
nerve  by  an  application  of  arsenic.  A  radiograph 
like  Figure  2  made  with  a  small  wire  in  the  root- 
canal  will  show  whether  the  apical  foramen  has 
been  reached.  The  removal  of  a  dying  nerve  and 
the  treatment  and  tilling   of  pulp-chamber   and 


Figure  4a. 


Figure  4b. 


root-canals  commonly  prevent  any  further  trouble. 
If  the  dying  nerve  is  not  treated,  it  dies  and 
breaks  down  into  a  liquid  mass  of  decayed  tissue 
which  often  has  a  foul  odor  from  the  presence  of 
microorganisms  of  putrefaction,  commonly  the 
streptococcus  viridans.  This  purulent  liquid  is 
under  pressure  and  the  apical  foramen  is  no 
longer  completely  blocked  by  living  tissue.  Infec- 
tion passes  into  the  alveolus  or  the  bony  socket 
and  soon  there  is  an  alveolar  abscess  surround- 


14     ROENTGENOGEAPHIC  DIAGNOSIS 


ing  the  apex  of  the  root.  Figures  3,  4:a  and  b, 
and  5  are  examples  of  alveolar  abscess  as  it  oc- 
curs in  the  mouths  of  prosperous  persons  whose 
teeth  have  always  been  carefully  treated  by  the 
best  dentists.  Of  course  at  a  clinic  one  can 
find  cases  of  extensive  necrosis  in  some  of  the 
worst  cases.  Figure  6  is,  however,  of  a  prosper- 
ous young  lady 
with  a  gold  probe 
passing  through 
the  root-canal  and 
a  fistulous  tract  in 
the  upper  jaw  and 
emerging  in  the 
nostrils.  This  was 
one  of  my  earliest 
pictures  and  not 
nearly  as  clear  as 
the  later  ones.  It 
is  especially  inter- 
esting to  note  that 
the  fistula  healed 
without  any  operative  treatment,  either  in  conse- 
quence of  the  x-YSij  exposure  or  of  the  stimula- 
tion through  the  passage  of  the  gold  probe. 

Very  many  if  not  most  of  the  cases  of  alveolar 
abscess  referred  for  ic-ray  examination  are  con- 
nected with  teeth  which  have  already  gone  through 
the  history  of  death  and  removal  of  the  nerve. 


FlGUKE   5. 


OF  DENTAL  INFECTION 


15 


The  rr-ray  often  shows  in  such  a  case  that  the 
root-canal  has  been  only  partly  filled.  A  cavity 
remains  in  the  tooth,  lodging  germs  which  keep 
up  infection  of  the  jaw  and  the  general  system 
and  on  occasion  start  an  abscess  in  the  jaw  bone. 
Figure  7  illustrates  this. 

Pyoekhea  Alveolaeis  {Also  Called  Riggs'  Dis- 


FlGUEE   6. 


Figure  7. 


ease). — This  is  another  disease  the  symptoms  of 
which  point  directly  to  the  teeth  and  which  the 
dentist  is  naturally  called  upon  to  treat.  The 
name  implies  a  discharge  of  pus  from  the  alveolus 
or  tooth  socket.  The  gums  around  certain  in- 
dividual teeth  are  swollen  and  usually  red  and 
bleeding,  but  sometimes  white  and  cartilaginous. 
Pressure  upon  the  gum  causes  an  escape  of  a  drop 
of  pus  along  the  neck  of  the  tooth.  And  this  may 
be  repeated  every  five  minutes.  Day  and  night 
this  discharge  of  pus  and  infected  blood  is  swal- 


16     ROENTGENOGRAPHIC  DIAGNOSIS 


lowed  with  tlie  saliva.  The  pus  comes  from  a 
pocket  extending  from  the  neck  of  the  tooth  per- 
haps even  beyond  the  apex  of  the  root.  The 
root  of  the  tooth  is  often  covered  by  dense  black 
adherent  calcareous  scales.  (See  Figure  31b,  page 
56,  shown  later  in  connection  with  a  special 
case.)     The  pocket  is  formed  by  greater  or  less 


Figure   8a. 
Figures   8a.   8b  axd  8c. 


Figure  8b. 
-Different  Stages  of  Pyorrhea. 


absorption  of  the  alveolar  process  surrounding 
the  affected  tooth.  The  pocket  may  be  demon- 
strated by  passing  an  instrument  into  it  as  is 
done  by  the  dentist  for  the  purpose  of  removing 
scales  and  applying  suitable  antiseptics.  In  the 
presence  of  the  scale-covered  root  of  the  tooth 
and  under  the  influence  of  the  constant  suppura- 
tion there  is  progressive  absorption  of  the  alveo- 
lar process  until  the  tooth  lies  loosely  in  a  large 
painful  cavity  from  which  it  is  an  act  of  mercy  to 
extract  it.  The  pocket  is  much  more  clearly  dem- 
onstrated by  the  rr-ray  as  reported  in  the  author's 


OF  DENTAL  INFECTTOX 


17 


various  papers  and  clinics  before  dental  conven- 
tions during  the  past  twelve  years. ^  The  radio- 
graphs referred  to  and  of  which  Figures  8a,  8b, 
and  8c  are  examples,  show  the  location  and 
extent  of  the  pocket.  And  in  many  cases  the  ra- 
diographs reveal  the  cause  of  the  pyorrheal 
pocket.  A  famous  ^ 
actress  was  re- 
ferred to  the  au- 
thor for  treatment,  i 
by  the  x-raj  and  | 
ultra-violet  ray,  of  ' 
pyorrhea  affecting 
the  left  upper  cen- 
tral incisor.  Fol- 
lowing my  usual 
custom,  I  made  a 
radiograjDh  of  the  *- 
affected  portion  of 
the  superior  max- 
illa and  found  an  unerupted  supernumerary  tooth 
pressing  upon  the  root  of  the  incisor  and  acting  as 
a  constant  source  of  irritation  (Figure  9a).  This, 
far  from  being  an  isolated  case,  is  but  one  of  nu- 
merous cases  of  pyorrhea  originating  from  a  sim- 
ilar cause.  Fig-ure  9b  shows  another  such  case.  Of 
course,  the  discovery  of  this  cause  affords  the  key 
to   successful  treatment  by   removal  of  the  un- 

^  See  bibliography  at  end  of  volume. 


FlGfKE   8c. 


18     ROENTGENOGEAPHIC  DIAGNOSIS 


erupted   tooth,    and   saves   the   patient   fruitless 
attempts  at  a  cure  by  other  means.     Figure  9c 


Figure  9a. 


FiGUKE  9c. 


Figure  9b. 


shows  how  clearly  an  un- 
erupted  tooth  is  demon- 
strated by  modern  appa- 
ratus and  technique.  In 
other  cases  the  x-ray 
shows  a  root-filling  ex- 
truded through  the  apical 
foramen  or  through  a 
false  passage  and  forming  an  irritant  foreign 
body.  Removal  of  the  offending  substance  either 
through  the  root-canal  by  enlarging  the  foramen, 
or  more  effectively  by  an  amputation  of  the  apex 
of  the  root,  cures  such  a  case,  and  other  methods 
of  treatment  must  necessarily  fail.    Figures  10a 


OF  DENTAL  INFECTION 


19 


and  10b  are  examples,  also  25b,  i^age  46.  A 
retained  root  (Figure  11a)  or  an  instrument 
broken  oft  in  tlie  bone  (Figure  lib),  will  some- 
times keep  up  a  discharge  of  pus.  It  used  to  seem 
desirable  to  allow  a  stump  to  remain  after  the 
crown  of  the  tooth  had  all  vanished  through  decay. 
This  was  on  the  theory  that  any  kind  of  a  root 
tended  to  prevent  absorption  of  the  alveolar  proc- 


FiGURE  10a.  Figure  10b. 

FiGUEES  10a  AND   10b. — Pyorrhea  Due  to  Extrusion  of  Root- 

FlLLIXG. 


ess  and  so  preserve  the  contour  of  the  face.  Re- 
cent cases  have  shown  that  this  is  sometimes  dan- 
gerous. In  one  case  (Figure  33c)  an  alveolar  ab- 
scess of  such  a  root  was  the  seat  of  infection  pro- 
ducing cardiac  and  arthritic  lesions.  In  another 
ease  (Figure  21a,  page  40)  infection  from  such 
a  retained  root  started  up  pyorrhea  in  a  neigh- 
boring tooth  and  acted  as  a  causative  factor  in 
neurasthenia. 


20     ROENTGENOGEAPHIC  DIAGNOSIS 

Pyorrhea  alveolaris  makes  the  teeth  very  sore 
and  in  the  tirst  case  treated  with  the  x-trj  the  pa- 


FlGURE  11a. 

tient,  a  medical  student  in  London,  had  to  warm 
his  beer  and  cool  his  tea.    The  dental  treatment 

also  is  exceedingly 
painful.  The  suf- 
fering and  the  in- 
evitable loss  of  the 
affected  teeth  and 
the  constant  ab- 
sorption of  pus, 
both  through  the 
local  circulation 
and  also  from  the 
..^j  discharge  that  is 
Figure  lib.  swallowed,  make  a 


OF  DENTAL  INFECTION  21 

cure  extremely  important,  and  especially  before 
too  great  bony  absorption  lias  occurred. 

The  treatment  of  pyorrhea  alveolaris  involves 
the  removal  of  any  cause  revealed  by  the  x-ray 
examination.  The  dentist  removes  the  hard  cal- 
careous scales  from  the  root  of  the  tooth  and 
makes  suitable  chemical  applications  to  the  pocket. 
This  treatment  by  the  dentist  is  indispensable,  but 
there  are  many  cases  in  which  these  measures 
alone  will  not  effect  a  cure.  The  author's  own 
practise  for  the  last  twelve  years,  when  such  cases 
have  been  referred  to  him  by  the  dentist,  has  been 
to  make  applications  of  the  x-xaj  and  high  fre- 
quency currents  from  ultra-violet  ray  vacuum  elec- 
trodes. The  author  was  not  the  first  to  do  this  and 
has  not  been  alone  in  his  observations  of  success- 
ful results,  but  it  certainly  requires  a  great  deal 
of  experience  and  study  in  this  particular  field 
to  make  applications  which  shall  be  effective 
through  the  flesh  and  bone  and  still  shall  have 
no  undesirable  effect  upon  the  skin.  The  practi- 
cability of  this  is  paralleled  in  other  fields  of 
Roentgen  ray  therapy,  as  when  an  application  to 
the  knees  in  a  case  of  leukemia  produces  an  ef- 
fect upon  the  bone  marrow,  the  nursery  of  white 
blood  cells,  reducing  the  number  of  leukocytes 
from  perhaps  200,000  to  perhaps  60,000  per  cu. 
mm.  Figure  12a  is  of  a  case  of  pyorrhea  alveo- 
laris referred  to  the  author  by  Dr.  Van  Saun. 


22     ROENTGENOGEAPHIC  DIAGNOSIS 

Very  extensive  pockets  were  present  about  several 
teeth  and  had  persisted  in  spite  of  dental  treat- 
ment. A  course  of  twelve  applications  of  the 
rr-ray  and  the  ultra-violet  ray  resulted  in  a  com- 
plete cure  and  at  the  last  report,  three  years  later, 
there  had  been  no  relapse.  Some  other  cases  re- 
quire a  longer  course  of  treatment  and  some  have 


Figure  12a.  Figure  12b. 

Figures   12a  and  12b. — Pyorrhea  Alveolaris  Before  Success- 
ful Treatment  by  X-Ray  and  High  Fre- 
quency Currents. 

occasional  relapses  which  are  disposed  of  by  den- 
tal treatment  and  a  very  few  x-yrj  and  ultra- 
violet ray  applications.  Figure  12b  is  of  another 
case  of  pyorrhea  cured  by  the  x-yslj  and  high  fre- 
quency currents. 

In  case  after  case,  the  pain  and  swelling  and 
discharge  have  ceased  and  the  loosened  teeth  have 
become  firm  again.  During  the  discussion  of  one 
of  the  author's  papers  at  the  meeting  of  the  Roent- 
gen Ray  Society  of  Greater  New  York,  this  ohser- 


OF  DENTAL  INFECTION  23 

vation  was  corroborated  hi/  Dr.  Goldberg,  luho 
had  treated  pyorrhea  at  one  of  the  large  hospi- 
tals. 

It  should  be  noted  that  the  author  does  not  rec- 
ommend this  treatment  as  a  substitute  for  treat- 
ment by  the  dentist,  but  only  as  an  adjunct  when 
dental  treatment  fails. 

The  author  regards  this  as  the  method  of  elec- 
tion and  has  applied  it  to  members  of  his  own 
family  as  well  as  to  strangers. 

There  is  a  new  method  of  treatment  for  pyor- 
rhea alveolaris  which  is  having  world-wide  pub- 
licity at  the  present  moment  and  which,  if  success- 
ful, will  have  the  advantage  over  the  a;-ray  of  not 
requiring  special  apparatus  or  special  skill  and 
of  being  therefore  very  much  less  expensive.  This 
is  by  the  use  of  the  ipecac  alkaloid  emetine.  This 
substance  acts  very  powerfully  upon  the  endameba 
which  is  assumed  by  the  proposers  of  the  treat- 
ment to  be  the  cause  of  pyorrhea  alveolaris.  So 
far  some  favorable  reports  have  been  published, 
but  the  author  has  heard  it  denounced  in  unmeas- 
ured terms  by  patients  upon  whom  it  had  been 
tried  without  a  particle  of  benefit.  It  is  evidently 
too  early  to  form  a  final  opinion  as  to  the  value  of 
the  emetine  treatment  of  pyorrhea  alveolaris,  but 
if  it  fails  in  a  given  case  or  should  prove  generally 
unreliable,  one  has  the  tried  and  proven  x-trj  and 
ultra-violet  ray  as  a  reliance. 


24     ROENTGENOGRAPHIC  DIAGNOSIS 


One  of  the  worst  cases  of  local  infection  the  au- 
thor has  ever  seen  was  referred  for  x-iaj  exam- 
ination by  Dr.  M.  H.  Brown.  There  was  a  cavity 
in  the  lower  jaw  opening  in  the  mouth  behind  the 
last  molar  tooth.  A  yard  of  the  foulest  gauze 
packing  was  drawn  out  and  it  seemed  as  if  noth- 
ing short  of  cancer  could  possibly  produce  such 
a  mass  of  corruption.     The  radiograph,  Figure 


FiGUBE  13a. 


Figure  13b. 


13a,  showed  a  large  thin-walled  cavity  in  the 
lower  jaw  at  the  bottom  of  which  was  an  un- 
erupted  supernumerary  tooth.  The  latter  lay  far 
from  the  ordinary  tooth-bearing  area. 

Another  case,  referred  by  Dr.  Fellowes  Davis, 
presented  swelling  and  a  fistulous  opening.  Into 
this  was  injected  a  bismuth  paste  by  means  of 
which  the  radiograph  Figure  13b  showed  the  path 
of  the  fistulous  tract  and  its  origin  in  a  root  at  a 
distance  from  the  swelling. 

Several  years  before  the  discovery  of  the  x-tslj, 
a  case  was  referred  to  the  author.    A  fistula  had 


^      r-, 


25 


ROENTGENOGRAPHIC  DIAGNOSIS     27 

been  discharging  externally  under  the  angle  of 
the  jaw  for  seven  years  in  spite  of  treatment  by 
the  best  physicians,  and  I  was  asked  to  recom- 
mend a  good  skin  specialist.  It  seemed  desirable 
to  introduce  a  probe  which  led  up  through  the  jaw 
bone  to  the  root  of  a  tooth.  And  it  was  a  simple 
enough  matter  under  a  general  anesthetic  to  ex- 
tract the  tooth  and  curette  the  bony  socket  and  the 
entire  length  of  the  fistulous  tract.  The  latter  was 
permanently  healed  in  ten  days. 

The  above  is  a  brief  exposition  of  some  of  the 
local  lesions  directly  affecting  the  teeth  which  may 
form  the  focus  of  constitutional  infections  pro- 
ducing an  amazing  variety  of  secondary  lesions 
and  symptoms. 

The  Focus  of  Infection  Not  Always  Con- 
nected WITH  the  Teeth. — A  case  in  point  was 
one  in  which  an  eye  and  ear  specialist  had  for 
two  years  and  a  half  suffered  tortures  from  pain, 
and  had  constitutional  symptoms  for  which  the 
ethmoid  cells  had  been  scraped  out  and  every 
upper  tooth  extracted.  The  pain  continuing,  spic- 
ules of  bone  had  been  cut  out  of  the  upper  jaw 
by  rongeur  forceps.  A  number  of  radiographs 
showed  no  retained  broken  root  of  a  tooth  as  had 
been  suspected  and  no  alveolar  abscess.  A  radio- 
graph of  the  whole  face  (Figure  14),  however, 
showed  that  one  antrum  was  absolutely  opaque. 
It  was  operated  on  by  Dr.  Cryer,  of  Philadelphia, 


28     ROENTGENOGRAPHIC  DIAGNOSIS 

who  removed  a  mass  of  pus  and  granulation  tissue 
and  the  pain  was  cured.  If  the  x-mj  had  been 
resorted  to  in  the  beginning,  two  and  a  half  years 
of  suffering  and  the  useless  extraction  of  all  the 
upper  teeth  would  have  been  avoided. 

The  x-raj  will  reveal  any  source  of  infection 
connected  with  the  teeth  or  the  pneumatic  sinuses 
of  the  face,  if  these  are  present.  If  these  were  un- 
discovered and  untreated,  the  most  serious  conse- 
quences might  follow  which  could  easily  have  been 
averted  and  which  may  be  exceedingly  difficult 
to  cure  after  they  have  developed.  A  case  in 
point  is  described  later  in  which  the  author  dis- 
covered the  cause,  but  the  teeth  seemed  perfectly 
sound  to  the  dentist  with  his  usual  means  of  ex- 
amination. The  patient,  himself  a  physician,  had 
terrible  neuritis,  high  blood  pressure  and  eventu- 
ally died  of  apoplexy,  apparently  from  neglect 
to  remove  the  cause  in  time. 


ROENTGENOGRAPHIC  DIAGNOSIS     29 


CHAPTER  III 

CONDITIONS     FEOM     WHICH     ALVEOLAE     ABSCESS     AND 
PYORRHEA  ALVEOLARIS    MUST    BE    DIFFERENTIATED 

Pulp-stones. — These  are  calcareous  concretions 
in  the  pulp  or  "nerve"  of  the  tooth.  They  cause 
pain,  and  the  patient  comes  for  a  radiograph 
which    is    expected    to     ^ 


show  the  location  of  an 
alveolar  abscess.  The 
picture,  however,  shows 
an  area  of  density  in 
what  should  be  the  per- 
fectly transparent  con- 
tents of  the  pulp-cham- 
ber. The  ''nerve"  is 
more  or  less  irritated  and  there  is  as  in  Figure 
15  a  slight  departure  from  the  normal  appear- 
ance of  the  bone  surrounding  the  apex  of  the  root. 
Such  cases  are  treated  by  removal  of  the  "nerve." 
Malocclusion. — Pain,  similar  to  that  of  chronic 
alveolar  abscess,  and  very  slight  radiographic  in- 
dications of  apical  irritation,  may  occasionally  be 
simply  the  result  of  constant  pressure,  this  tooth 
alone  making  contact  with  the  opposing  teeth 
when  biting  or  chewing.  The  dentist  can  remedy 
the  cause  by  regulating  the  teeth  slightly  or  by 


Figure  15. 


30     ROENTGENOGRAPHIC  DIAGNOSIS 

gTinding  the  surface  of  this  tooth  or  the  one  it 
collides  with.  This  explanation  of  the  case  should 
be  accepted  with  more  than  the  traditional  grain 


Figure   16a. 


r 


Figure  16b. 


Figure  16c. 


Figures  16a,  16b  and  16c. — Apical  Abscess  in  Case  of  Arthri- 
tis, Endocarditis,  Meningitis,  Pleurisy,  Pneumonia   • 
AND  Hemiplegia. 

Discomfort  at  first  considered  due  to  malocclusion. 


of  salt.  Of  course  if  the  pain  ceases  and  the 
radiographic  appearance  becomes  normal,  that  is 
all  that  can  be  desired.    But  if  more  or  less  dis- 


OF  DENTAL  INFECTION  31 

comfort  remains  and  the  radiographic  appearance 
continues  distinctly  abnormal,  the  case  should  not 
be  temporized  with  even  though  the  usual  tests 
by  the  dentist  indicate  a  vital  and  healthy  tooth. 
Figures  16a  and  16b  show  the  progress  of  such 
a  case  under  expectant  treatment.  The  symptoms 
and  radiographic  appearance  at  the  start  were  as 
described  above.  Grinding  the  surfaces  of  the 
opposing  teeth  did  away  with  their  collision,  but 
the  discomfort  and  abnormal  radiographic  ap- 
pearance persisted  for  years.  Then  there  was  an 
attack  of  intense  pain  necessitating  the  use  of 
morphin  and  accompanied  by  swelling  and  sup- 
puration. This  required  months  of  treatment 
through  the  root-canal.  Figure  16c  shows  the 
same  tooth  a  year  later  with  the  root  filled  to 
the  apex  and  surrounded  by  healthy  bone.  It 
proved  to  be  sterile  when  extracted  (page  49). 

The  treatment  of  just  such  a  case  should,  ac- 
cording to  the  author's  view,  consist  in  drilling 
into  the  tooth  and  removing  the  dead  or  dying 
or  simply  chronically  irritated  nerve.  This  should 
be  done  before  its  putrid  decomposition  has  poi- 
soned the  alveolus  or  bony  socket  almost  beyond 
recovery. 

The  very  serious  subsequent  developments  in 
the  case  of  this  patient  are  described  at  page 
46. 

Cysts. — A  cyst  in  either  the  upper  or  the  lower 


32     ROENTGENOaRAPHIC  DIAGNOSIS 


jaw  may  cause  symptoms  resembling  those  of 
alveolar  abscess  and  the  radiographer  should  be 
careful  to  differentiate  between  the  two.  In  a  re- 
cent case  (Figure  17a),  treated  by  Dr.  Clawson, 
there  was  a  large  area  of  transparency  between 
the  roots  of  the  lateral  incisor  and  the  canine. 


Figure  17a. 


Figure  17b. 


Both  these  teeth  had  healthy  ''nerves."  The  cyst 
contained  a  clear  straw-colored  liquid  and  was 
successfully  treated  by  incision,  curettage  and 
packing  without  disturbing  the  two  neighboring 
teeth.  Figure  17b  shows  a  cyst  accidentally  re- 
vealed in  a  radiograph  made  to  determine  the 
presence  of  an  unerupted  upper  canine  tooth  in 
a  man  45  years  old.  A  large,  thin- walled,  clearly 
defined  cavity  is  frequently  a  cyst ;  while  an  alve- 
olar abscess  often  is  evidenced  by  decalcification 


OF  DENTAL  INFECTION 


33 


gradually  shading  oft*  into  healthy  bone  without 
a  distinct  line  of  demarcation. 

A  dentigerous  cyst  commonly  shows  as  a  hard 
swelling  upon  the  jaw  and  is  essentially  a  cavity 
in  the  bone  wherein  lies  an  unerupted  and  usu- 


HH 

/  '""'^-^i^^BS/M 

%      i 

-w4 
A 

FiGUEE  ISa. 

ally  supernumeraiy 
tooth.  Exceptionalh^ 
the  a?-ray  shows  that 

such  a  swelling  is  an  Figure  ISb. 

odontoma,  a  tumor  of 

almost  stony  hardness  and  consisting  of  a  con- 
glomeration of  nodules  of  dentine  covered  by 
enamel. 

Alveolae  Abscess  and  Unerupted  Tooth  Com- 
bined,— In  a  patient  seventy  years  old  with  pain- 
ful swelling  of  the  lower  jaw,  the  dentist  could 
not  determine  whether  the  cause  was  an  unerupted 
tooth  or  an  alveolar  abscess.  The  radiograph 
(Figure  18a)  showed  that  both  conditions  were 
present.     Another  patient  aged  fifty  years  was 


34    ROENTGENOGRAPHIC  DIAGNOSIS 


referred  for  an  exam- 
ination to  determine  the 
presence  of  an  nnerupt- 
ed  upper  canine.  The 
radiograph  (Figure 
18b)  showed  the  un- 
erupted  tooth  and  an 
unsuspected  alveolar 
abscess  of  an  upper  molar. 
An  IMPACTED  WISDOM  TOOTH  lying  perhaps  in  a 


FiGUEE  IDa. 


Figure  19b. 
Flariiig  apical  foramina  of  the   12-year  molar  are  normal.     Ab- 
scess of  the  anterior  root  of  the  6-year  molar. 


OF  DENTAL  INFECTION  35 

horizontal  position  concealed  in  the  jaw  and  grow- 
ing directly  against  the  root  of  the  second  molar, 
causes  pain  suggestive  of  neuralgia  or  neuritis.  It 
is  mentioned  in  this  place  because  of  the  misin- 
terpretation that  has  sometimes  been  made  of  the 
radiographic  appearance.  The  unerupted  tooth 
(Figure  19a)  lies  in  a  natural  cavity  in  the  jaw 
and  if  the  root  is  not  fully  developed  a  trans- 
parent area  is  seen  at  that  end.  This  represents 
soft  tissue  in  which  tooth  substance  is  developing 
and  is  not  an  abscess. 

The  FLARING  FOEAMEN  of  a  still  gTowiug  tooth  in 
a  young  person  should  not  be  mistaken  for  an 
abscess.  Figure  19b  shows  a  case  with  both  ab- 
scess and  this  normal  appearance. 


36     ROENTGENOGRAPHIC  DIAGNOSIS 
CHAPTER  IV 

KECENT    BACTERIOLOGICAL    AND    CLINICAL    STUDIES 

Hartzell,  Henrici  and  Leonard  ^  have  been  able 
to  verify  the  statement  that ''para-apical  abscesses 
and  pyorrheal  pockets  both  harbor  streptococci 
which  will  induce  in  animals  inflammation  of  the 
heart  muscle,  vegetations  in  heart  valves,  infected 
joints,  inflammation  in  blood-vessels,  inducing  vas- 
cular lesions  and  both  focal  and  diffused  infec- 
tions of  the  kidneys."  During  the  past  year  they 
found  similar  post  mortem  human  lesions  particu- 
larly of  the  heart  valve,  heart  muscle  and  kidney, 
which  they  believe  are  produced  by  the  same  or- 
ganisms. The  medical  department  of  the  Minne- 
sota University  Medical  School  report  that  12  per 
cent  of  the  individuals  admitted  to  the  hospital  are 
suffering  from  conditions  due  to  mouth  infec- 
tion. Their  bacteriological  work  shows  the  con- 
stant presence  of  the  streptococcus  viridans  in 
chronic  dental  abscesses  and  pyorrheal  pockets 
and  a  sterile  condition  of  healthy  teeth.  Hemo- 
lytic streptococci  are  absent  from  these  abscesses 
and  from  pyorrhea.    The  pneumococcus  is  absent. 

^  The  report  of  The  Minnesota  Division  of  the  Scientific  Foun- 
dation and  Kesearch  Commission,  Journal  of  National  Dental  As- 
sociation, November,  1915. 


OF  DENTAL  INFECTION  87 

Their  studies  convince  them  that  peridental  in- 
flammations are  primary  lesions,  the  organisms 
gaining  access  to  the  tissues  either  through  the 
pulp  canal  or  at  the  gingival  margin,  and  not  sec- 
ondary to  some  other  focus.  Their  studies  of  the 
endameba  buccalis  confirm  the  statement  of  Bass 
and  others  that  these  organisms  are  practically 
always  present  in  diseased  mouths,  but  they  do  not 
find  them  most  numerous  in  the  deep  parts  of  the 
pockets  nor  in  the  tissues.  They  find  these  amebae 
in  the  pus  which  contains  their  natural  food, 
this  being  bacteria  and  pus  cells.  They  are  un- 
able to  confirm  a  causative  relation  between 
the  endameba  and  pyorrhea  and  alveolar  ab- 
scess. 

In  the  medical  wards  they  have  studied  espe- 
cially arthritis,  acute  and  chronic  ulcer  of  the 
stomach,  heart  lesions,  pernicious  anemia,  ne- 
phritis and  nervous  diseases  of  the  neuralgic  type. 
They  find  no  important  distinction  between  dental 
abscess  and  pyorrhea  as  causative  factors  in  these 
diseases.  Either  is  frequently  the  sole  cause  and 
even  in  cases  originating  from  tonsillar  or  other 
large  focus  of  infection,  the  presence  of  pyorrhea 
or  dental  abscess  will  keep  up  the  disease  after 
the  large  focus  has  been  cured.  All  these  cases 
are  markedly  improved  by  complete  extirpation 
of  these  foci  of  infection.  To  quote  from  Dr. 
Leonard's  report: 


38    ROENTGENOGRAPHIC  DIAGNOSIS 

' '  A  minute  examination  with  every  means  avail- 
able is  necessary.  With  the  aid  of  the  x-YSij  and 
careful  exploration,  it  is  still  difficult  to  find  all 
foci  about  the  teeth.  Without  these  aids  it  is  im- 
possible. When  a  physician  refers  a  patient  suf- 
fering from  rheumatism  or  other  disease  liable 
to  come  from  dental  infection,  it  is  impossible  for 
the  dentist  to  make  a  complete  determination  with- 
out the  use  of  the  x-yslj.  It  is  our  experience  and 
the  experience  of  others  who  use  the  x-yslj  a  good 
deal  that  the  majority  of  dental  abscesses  give  no 
clinical  sign  of  their  existence.  The  teeth  are  not 
sore,  no  swelling  or  palpable  soft  spot  at  the  root 
end  reveals  what  the  radiograph  shows  and  what 
the  subsequent  operation  confirms.  It  is  not  un- 
common to  find  abscesses  shown  in  the  radio- 
graphs in  cases  in  which  there  are  no  breaks  in 
continuity  of  the  pulpal  wall,  as  under  crowns, 
fillings  or  even  sound  teeth. 

'' Experience  with  radiography  also  shows  that 
a  very  large  proportion  of  artificially  filled  roots 
subsequently  become  abscessed.  A  study  made 
by  Dr.  Henry  Ulrich  of  Minneapolis  of  a  thousand 
radiographs  taken  at  random  indicated  that  over 
70  per  cent  of  the  artificially  filled  roots  were  ab- 
scessed. We  partially  checked  this  up  by  look- 
ing over  a  hundred,  in  which,  according  to  our 
diagnosis,  over  60  per  cent  of  such  were  ab- 
scessed. A  consideration  of  the  necessary  means 
to  do  away  with  this  condition  is  out  of  place  in 
this  report.  The  point  is,  that  this  must  be  taken 
into  account  in  a  determination  of  dental  foci  in 
cases  suffering  from  systemic  disease.  It  has 
been  very  rare  that  we  have  extracted  a  tooth 
which  showed  an  abscess  in  the  radiograph  and 
failed  to  get  streptococci  when  we  cultured  from 


OF  DENTAL  INFECTION  39 

tlie  root  end.  Our  technique  is  sucli  that  con- 
tamination in  making  these  cultures  seems  impos- 
sible. 

' '  It  is  amazing  to  find  in  well  cared  for  mouths 
how  much  pyorrhea  may  exist  without  being  evi- 
dent except  to  painstaking  exploration.  To  those 
familiar  with  systemic  results  coming  from  pyor- 
rhea in  such  a  large  proportion  of  cases  and  even 
from  a  slight  pyorrhea,  the  careless  ignoring  and 
overlooking  of  such  trouble  on  the  part  of  most 
dentists,  seems  nothing  less  than  malpractise. 

^  ^  ^  ^  ^  ^  ^ 

''The  last  year's  work  has  tllro^\^l  some  doubt 
on  the  advisability  of  the  use  of  vaccines  in  all 
of  the  cases.  There  is  no  question  but  that  bril- 
liant results  frequently  follow  the  use  of  autogen- 
ous vaccines  or  even  those  prepared  for  similar 
lesions  in  other  patients.  A  vaccine  prepared 
in  the  case  of  Miss  A.  F.,  whose  case  is  given 
above,  was  used  by  one  of  the  physicians  for  an- 
other rheumatic  case,  in  his  opinion  with  satis- 
factory results.  The  use  of  vaccines,  hoivever,  is 
liable  to  create  a  confidence  in  them  which  is 
likely  to  make  the  dentist  less  careful  in  eliminat- 
ing all  local  foci,  and  until  such  local  foci  are  re- 
moved it  can  hardly  he  expected  that  a  vaccine  luill 
give  any  permanent  relief.  In  most  of  the  cases 
where  we  were  sure  that  all  local  foci  were  re- 
moved the  recovery  was  sufficiently  rapid  and 
complete  to  indicate  that  vaccine  was  not  needed. ' ' 

Four  cases  had  a  diagnosis  of  myocarditis  and 
three  of  pericarditis.  Removal  of  the  causative 
foci  of  infection  prevented  further  damage  to 
the  heart  in  valvular  cases  and  general  medical 
measures  were  adopted  to  favor  compensation. 


40     ROENTGENOGRAPHIC  DIAGNOSIS 


CHAPTER  V 


LESIONS     AND     SYMPTOMS     SECONDAEY     TO     INFECTION 
CONNECTED  WITH   THE   TEETH  OR  THE  PNEU- 
MATIC  SINUSES    OP   THE  FACE 

Tuberculosis. — It  has  long  been  known  ^  that 
one  of  the  common  sites  of  infection  in  pulmonary, 
bony  and  glandular  tuberculosis   is  an  alveolar 

abscess.  And  the  con- 
tinued existence  of  such  a 
pus  pocket  is,  therefore, 
a  distinct  menace  to  life 
itself.  Figure  20  shows 
such  an  abscess  in  a 
patient  shortly  before 
death  from  tuberculosis. 
Neurasthenia. — A  man 


Figure  20. 


Figure  21a.  Figure  21b. 

^  Tousey,  ' '  Medical  Electricity,  Eoentgen  Eays  and.  Eadium. ' ' 
W.  B.  Saunders  Co.,  Philadelphia. 


Figure    22. — Fro^'tal    Sinus    Opaque   in    a    Case    of    Neuras- 
thenia.    Anteroposterior  View. 


41 


&4       H 


fin 


43 


ROENTGENOGRAPHIC  DIAGNOSIS     45 

of  powerful  physique  and  weighing  220  pounds, 
was  lately  referred  to  me  suffering  from  neuras- 
thenia. He  complained  chiefly  of  not  being  able 
to  stand  as  much  business  activity  and  respon- 
sibility as  one  of  his  apparent  strength  would  be 


r 


M  ^ 


••* 


J  ^ 


Figure    24. — Alveolab  Pigure  25a.— Pyorrhea  in 
Abscess  ix  Digestive  Spinal  Arthritis. 

Neurasthenia      and 
fueunculosis. 

expected  to.    There  had  been  no  dental  but  some 
nasal  symptoms. 

The  radiographs  showed  several  pyorrheal 
pockets  including  (Figure  21a)  one  of  the  right 
lower  second  bicuspid  due  probably  to  irritation 
from  the  retained  and  infected  roots  of  the  first 
molar.  An  antero-posterior  and  also  a  lateral 
radiograph  of  the  head  showed  the  frontal  sinus 
to  be  opaque  either  from  pus  or  some  other  opaque 
substance  or  because  of  congenital  absence  of  the 


46     ROENTGENOGEAPHIC  DIAGNOSIS 

frontal  sinus.    Dr.  Culbert,  the  rhinologist,  tliinks 
the  latter  is  the  case. 

In  another  case  of  neurasthenia  applying  to  the 
author  for  x-rsij  examination,  the  radiograph 
(Figure  21b)  showed  an  alveolar  abscess  with  ero- 
sion of  a  considerable  part  of  the  root.  The  canal 
was  only  partly  filled  and  the  foramen  wide  open. 


Figure  25b. 


Figure  25c. 


Akthkitis  has  become  known  within  the  last 
few  years  to  be  frequently  due  to  toxemia  origi- 
nating from  and  maintained  by  an  alveolar  ab- 
scess or  pyorrheal  pockets.  Figures  25a,  25b  and 
25c  illustrate  dental  infections  in  these  cases.  And 
since  this  discovery  many  a  case  of  acute  or 
chronic  '' rheumatism"  has  been  cured  in  a  short 
time  by  treating  the  focus  of  infection. 

Aetheitis,  Pleueisy,  Endocaeditis,  Meningitis 
AND  Hemiplegia. — A  patient  was  referred  to  on 
page  30  with  a  lower  first  bicuspid  which  the 
dentist  at  first  thought  was  simply  irritated  by 


OF  DENTAL  INFECTION  47 

striking  against  an  ujjper  tooth.  This  went  on  to 
the  formation  of  an  alvejolar  abscess.  Following 
prolonged  treatment  through  the  root-canal  the 
tooth  was  filled. 

Figure  26  shows  this  tooth  in  an  apparently 
cured  condition.     The  root  filling  reaches  about 
to  the  apical  foramen  and  the     ^    ~ 
surrounding  bone   has   regen- 
erated.   During  the  latter  part 
of  the  summer,  the  patient  be- 
gan  to    complain   of   renewed 
discomfort  and  wanted  to  have 
the  tooth  extracted,  but  a  ra- 
diograph showed  it  to  be  all 
right.     There  was  a  peculiar 

^  ^     .  Figure  2G. 

appearance  to  the  adjacent 
second  bicuspid.  Then  followed  a  series  of  fugi- 
tive attacks  of  arthritis,  myositis  and  neuritis. 
Each  attack  lasted  a  week  or  ten  days  and  pro- 
duced very  severe  pain.  During  these  two  months 
the  patient  lost  twenty  pounds  in  weight  and  at 
times  had  a  slight  rise  in  temperature.  A  diet 
from  which  sugar  and  meat  were  excluded  and 
medication  by  aspirin,  salophen  and  sodium  sa- 
licylate produced  little  or  no  elf ect.  Finally  a  few 
applications  of  high  frequency  currents  from  ul- 
tra-violet vacuum  electrodes  seemed  to  have 
brought  these  attacks  to  an  end.  On  December 
5th,  however,  she  was  seized  by  sudden  severe 


48     ROENTGENOGRAPHIC  DIAGNOSIS 

pain  in  the  left  npper  quadrant  of  tlie  abdomen 
with  great  rigidity  of  the  left  rectus  muscle.  This 
pain  was  not  relieved  by  laxatives  and  enemata 
and  gradually  extended  to  the  left  side  of  the  chest, 
where  in  two  or  three  days  the  physical  signs  of 
pleurisy  with  effusion  developed.  The  heart  was 
greatly  dilated  and  there  were  rasping  mitral 
murmurs.  Absolute  rest  in  bed,  a  purin-free  diet 
and  an  ice  bag  over  the  heart  temporarily  reduced 
the  severity  of  the  symptoms  without  much  change 
in  the  physical  signs. 

After  five  weeks  of  this  acute  illness,  Dr.  Harlow 
Brooks  in  consultation  found  that  she  presented 
the  clinical  picture  of  tubercular  peritonitis  and 
tuberculous  pleurisy  on  the  left  side.  There  was 
also  flatness  at  the  base  of  the  right  lung  behind, 
which  with  the  onset  of  meningitic  symptoms  and 
constant  leukocytosis  led  to  a  suspicion  of  ab- 
scess which  was  disproven  by  an  exploratory 
puncture. 

The  meningeal  symptoms  became  rapidly  worse ; 
the  patient  was  unable  to  speak  a  connected  sen- 
tence. There  were  several  severe  convulsions 
lasting  from  an  hour  to  an  hour  and  a  half  each. 
A  spinal  puncture  showed  a  clear  fluid  under  nor- 
mal pressure  and  containing  no  microorganisnls, 
and  negative  to  the  Wassermann  test.  The  spinal 
fluid  contained  one  lymphocyte  to  about  15  red 
cells.    The  blood  contained  no  microorganisms  and 


Figure  27.^Dilated  Heaet,  Enlarged  Thymus  and  Mottling 

OF  Lung. 

Case    of    arthritis,    endocarditis,    pleurisy,    pneumonia,    meningitis 

and  hemiplegia  from  dental  infection. 


49 


ROENTGENOGRAPHIC  DIAGNOSIS     51 

was  negative  to  the  Widal  and  Wassermann  tests 
and  contained  25,000  leukocytes  per  cubic  milli- 
meter. The  urine  contained  albumin  and  casts,  A 
radiograph  of  the  chest  (Figure  27)  made  with  a 
portable  outfit  showed  no  collection  of  fluid  in 
either  side  of  the  chest,  but  mottling  on  the  right 
side.  It  showed  a  greatly  dilated  heart  and  an 
enlarged  thymus  gland.  The  pulse  was  120,  respi- 
ration 34,  temperature  102 1/>  degrees  F. 

Dr.  N.  B.  Potter  and  his  assistant.  Dr.  Ord- 
way,  had  always  been  suspicious  of  streptococcus 
infection,  possibly  from  the  teeth  shown  in  my 
radiographs.  And  it  had  been  the  plan  that  the 
first  time  the  patient  went  out  of  doors  it  should 
be  to  the  dentist's  office  to  have  the  suspected  sec- 
ond bicuspid  drilled  into  and  the  question  of  the 
life  or  death  of  its  nerve  decided.  It  had  now 
become  evident,  however,  that  it  was  a  question 
of  the  life  or  death  of  the  patient  to  discover 
and  remove  the  source  of  infection  at  once  un- 
less it  should  prove  to  be  tubercular  and  not 
removable.  Dr.  Henry  Sage  Dunning  accordingly 
operated  upon  the  patient  in  bed  under  local  an- 
esthesia. He  extracted  the  originally  infected  first 
bicuspid  without  difficulty.  The  hooked  root  of 
the  second  bicuspid  broke  off  as  had  been  antici- 
pated and  had  to  be  chiseled  out.  The  operation 
took  about  two  hours,  but  was  entirely  painless. 

Improvement  in  every  particular  began  from 


52     ROENTGENOGRAPHIC  DIAGNOSIS 

that  moment.  The  original  tooth  was  found  to 
be  sterile,  but  a  culture  of  the  streptococcus  viri- 
clans  was  obtained  from  the  second  bicuspid  and 
on  the  fifth  day  after  the  operation  inoculations 
with  autogenous  vaccine  were  begun.  After  this 
the  improvement  was  more  rapid  and  on  the 
thirteenth  day  after  the  removal  of  the  teeth  the 
respiration  was  24,  pulse  74,  temperature  98  de- 


FlGUKE    28. 


Figure  29. 


grees  F.,  and  the  patient's  strength  increasing 
daily.  The  physical  signs  were  clearing  up.  The 
subsequent  course  of  this  case  has  been  remark- 
able. The  patient  has  recovered  from  an  attack 
of  pneumonia  and  has  partly  recovered  from 
hemiplegia  supposed  to  be  due  to  an  embolus. 
She  is  still  in  bed  running  an  irregular  septic  tem- 
perature and  the  only  treatment  that  seems  to 
have  any  beneficial  effect  is  the  inoculation  with 
a  dead  culture  of  the  streptococcus  viridans.  It 
is  believed  that  if  her  strength  holds  out  her  re- 
sistance to  the  infection  will  be  increased  to  such 


Figure  -"^n. — Unfkhpied  'iooin  in  the  T  owek  Jaw. 

Facial  neuralgia  for  which  extirpation  of  the  Gasserian  ganglion 

was  planned. 


53 


ROENTGENOGRAPHIC  DIAGNOSIS     55 

an  extent  as  to  bring  about  recovery.  The  case 
at  present  seems  to  be  one  of  endocarditis  with 
vegetations  upon  the  heart  valves  which  occa- 
sionally produce  infarctions  in  such  organs  as  the 
spleen  and  kidneys,  where  the  consequences  are 
very  serious. 

Neubitis,  neukalgta,  tic  douloureux,  sciatica, 
constitute  a  group  of  cases  in  which  one's  first 
thought  is  to  determine  the  presence  or  absence 
of  a  cause  connected  with  the  teeth  or  sinuses, 
for  no  ordinary  medical  agents  will  avail  if  the 
trouble  is  due  to  such  a  cause.  Figure  28  is 
an  example  of  positive  findings  in  these  cases. 
Figure  29  shows  one  of  the  dental  foci  of  in- 
fection in  a  case  of  headache  persisting  for  3  or 
4  years  in  spite  of  medical  and  hygienic  measures. 
Another  patient  had  very  severe  tic  douloureux 
spasms  of  pain  at  a  few  seconds'  interval,  feeling 
exactly  as  if  a  tack  were  driven  into  the  jaw  bone. 
The  x-iaj  and  high  frequency  currents  from  ul- 
tra-violet ray  vacuum  electrodes  gave  a  great  deal 
of  relief,  but  the  final  cure  was  accomplished 
through  overcoming  intestinal  auto-intoxication, 
which  appears  to  have  been  the  underlying  cause. 
The  negative  x-raj  findings  saved  the  patient 
from  needless  and  ineffective  sacrifice  of  his  teeth. 
Figure  30  is  of  a  case  referred  by  the  late  Wm. 
T.  Bull.  The  patient  had  been  treated  by  neurolo- 
gists and  electrologists  in  this  country  and  Paris 


56     ROENTGENOGEAPHIC  DIAGNOSIS 


for  trigeminal  neuralgia  which  had  persisted  for 
three  years.  Dr.  Bull  had  arranged  to  perform  an 
operation  for  the  removal  of  the  Gasserian  gan- 
glion, but  as  a  final  preparatory  step  sent  her  for 
an  x-iaj  examination.  The  pictures  showed  an 
unerupted  tooth  near  the  angle  of  the  jaw,  which 
Dr.  Bull  operated  upon  with  a  cure  of  the  dis- 


FiGUEE  31a. 


FiGtTRE  31b. 


ease  and  the  patient  was  saved  the  fruitless  suf- 
fering and  danger  of  an  intra-cranial  operation. 

Pakoxysmal  Cough. — Such  a  case  in  a  man  who 
has  recently  become  blind,  was  referred  to  the  au- 
thor by  Dr.  Osborne.  The  radiographs,  among 
them  being  Figures  31a  and  31b,  showed  alveolar 
abscess  and  numerous  pyorrheal  pockets.  Dental 
treatment  not  having  been  beg-un,  the  calcareous 
scales  are  clearly  visible  upon  the  root  of  one  of 
the  lower  centrals. 

Cases  of  aeteeial  hypeetension,  leading  to  ae- 


OF  DENTAL  INFECTKJN 


57 


TERioscLERosis  witli  maiiy  distressing  symptoms 
and  a  prospect  of  apoplexy  and  death,  call  for  an 
a:;-ray  examination  of  the  teeth  and  pneumatic 
sinuses.  Figure  32a  showed  extensive  pyorrheal 
and  abscess  areas  about  the  teeth.  The  patient 
was  professor  of  laryngology  and  rhinology  in  one 


Figure  32a. 


of  our  universities  and  had  been  referred  to  me 
for  treatment  of  neuritis  of  the  arm.  He  was  un- 
der treatment  elsewhere  for  high  blood-pressure, 
which  I  thought  was  of  the  same  toxic  origin  as 
the  neuritis.  Suspecting  dental  infection,  I  made 
the  radiographs  which  showed  the  area  of  infec- 
tion. I  most  strongly  urged  treatment  either  by 
extracting  the  alTected  teeth  or  by  applications 
made  through  the  root-canals.  The  dentist,  how- 
ever, found  the  teeth  healthy   according  to  his 


58     ROENTGENOGRAPHIC  DIAGNOSIS 

tests  and  refused  credence  to  the  ic-ray  findings. 
It  was  before  the  general  recognition  of  tliis 
source  of  systemic  infection  and  so  the  doctor 
was  allowed  to  go  from  bad  to  worse  until  he  was 
in  a  desperate  condition  in  the  Battle  Creek  Sani- 
tarium.   There  he  met  a  dentist  who  believed  the 


Figure  32b. 


Figure  32c. 


story  told  by  the  radiographs.  A  number  of 
terribly  abscessed  teeth  were  extracted  with  im- 
mediate and  marked  constitutional  benefit,  but  on 
his  return  to  New  York  the  radiograph  (Figure 
32b)  showed  other  infected  areas  remaining  in 
the  upper  jaw  from  which  all  the  teeth  had  been 
extracted  and  in  a  few  weeks  he  died  of  apoplexy. 
Timely  extraction  of  all  the  infected  teeth,  I  be- 
lieve, would  have  saved  this  useful  life.  He  was 
only  56  years  old. 


OF  DENTAL  INFECTION 


59 


Figure  32c  is  of  a  lady  with  high  blood-pres- 
suEE,  seldom  lower  than  220,  and  with  auricular 
fibrillation    and    occasional    syncope — altogether 


Figure  33a. 


Figure  33b. 


FlGURK    33c. 


Figures  33a,  33b  and  33c. — Alveolar  Abscesses  ix  a  Case  of 
Mitral  IivSLTirFiciEXCY. 


calling  for  the  immediate  sacrifice  of  the  infected 
teeth  if  her  life  is  to  be  saved. 

Caediac  lesions  secondary  to  dental  infection 
with  its  accompanying  rheumatism,  nephritis  or 


60     ROENTGENOGRAPHIC  DIAGNOSIS 

neuritis,  were  endocarditis  in  twenty-three  out 
of  thirty-one  of  Hartzell,  Henrici  and  Leonard's 
cases  and  were  evidenced  by  valvular  disease,  usu- 
ally mitral  insufficiency.  Four  cases  had  a  diag- 
nosis of  myocarditis  and  three  of  pericarditis.  Re- 
moval of  the  causative  foci  of  infection  prevented 
further  damage  to  the  heart  in  valvular  cases  and 
general  medical  measures  were  adopted  to  favor 
compensation. 

Cardiac  lesions  have  already  been  referred  to; 
and  Figures  33a,  33b  and  33c  are  of  a  case  in 
which  they  are  the  most  important  result  of  dental 
infection.  The  patient  has  a  mitral  murmur,  mit- 
ral regurgitation  with  some  compensatory  en- 
largement of  the  heart,  but  no  edema  of  the  ex- 
tremities or  dyspnea.  Getting  up  quickly  from  a 
reclining  posture  would  cause  him  to  drop  back 
practically  in  a  faint  and  he  has  to  avoid  turning 
suddenly  for  the  same  reason.  The  urine  contains 
numerous  granular  casts,  calcium  oxalate,  uric 
acid  and  formerly  contained  albumin.  The  recent 
occurrence  of  a  swelling  of  one  or  two  finger  joints 
and  one  knee  caused  him  to  have  radiographs 
made  of  all  the  teeth.  Pyorrheal  pockets  were 
found  about  several  teeth;  and  there  were  three 
alveolar  abscesses  with  considerable  destruction 
of  bone.  The  three  abscessed  teeth  were  extracted. 
The  first  two  contained  no  pathogenic  microor- 
ganisms.   The  third  yielded  a  culture  of  strepto- 


OF  DENTAL  INFECTION 


61 


coccus  viridans  from  which  an  autogenous  vac- 
cine has  been  prepared. 

Exophthalmic  Goitre. — This  is  a  disease  in 
which  an  ic-ray  examination  of  the  teeth  is  very 
necessary.  Arising  in  youth  as  it  often  does, 
it    might    seem    unlikely    that    a    dental    infec- 


Fi3UEE    34a. 


Figure   34)j. 


tion  should  have  been  present  as  an  exciting 
cause.  Figure  5  (page  14),  however,  is  a  pic- 
ture of  a  young  girl  with  an  alveolar  abscess,  and 
Figure  19b  (page  34)  is  another.  In  nearly  every 
family  some  case  of  dental  abscess  can  be  found  to 
have  occurred  during  youth  or  childhood.  Those 
with  manifest  symptoms  have  usually  been  treated 
more  or  less  successfully,  but  the  x-yrj  alone 
would  have  disclosed  those  with  an  insidious 
course.  Figures  34a  and  34b  show  typical  dental 
x-YSLj  findings  in  exophthalmic  goitre.  In  one 
case  there  had  been  alveolar  abscesses   of  two 


62     ROENTGENOGEAPHIC  DIAGNOSIS 

lower  molars  for  a  long  time.  In  the  other  case  all 
the  upper  and  lower  teeth  except  two  or  three  iso- 
lated ones  had  been  lost  through  pyorrhea. 

Eye  Diseases. — Some  of  the  cases  which  were 


Figure    35a. — Alveolar    Abscesses    in    Case    of    Tinnitus 

AuRIUM. 


Figure  35b.  Figure  35c. 

Figures  3ob  and  35c. — Alveolar  Abscesses  and  Pyorrhea  in 

Case  of  Pernicious  Anemia  and  Spinal  Sclerosis. 

formerly  diagnosed  as  due  to  rheumatism  or  to 
syphilis  have  been  found  to  be  due  to  dental  infec- 
tion. The  uveal  tract  including  the  choroid,  the  cil- 
iary body  and  the  iris,  is  most  apt  to  be  affected  by 


OF  DENTAL  INFECTION  63 

this  cause.  Cases  have  been  known  in  which  even 
one  eye  has  been  lost  and  this  cause  of  infection 
discovered  in  time  to  save  the  other.  The  pa- 
tient represented  by  radiograph  No.  Ki  liad 
neuroretinitis  as  an  effect  of  meningitis  and  at 
another  stage  episcleritis  as  a  direct  effect  of  the 
infection  or  as  a  reaction  from  the  autogenous 
vaccine.  The  patient  in  radiographs  Figures  31a 
and  31b  became  blind  and  without  any  perception 
of  light  shortly  before  the  infection  was  discov- 
ered, but  perhaps  not  in  consequence  of  it. 

Tinnitus  aueium  was  the  symptom  complained 
of  by  a  patient  referred  to  me  by  Dr.  Clawson. 
The  radiographs  showed  no  dental  lesion.  Figure 
35a,  on  the  other  hand,  show^s  three  alveolar  ab- 
scesses in  a  physician  with  a  noise  as  of  ten  thou- 
sand crickets  in  each  ear.  The  ringing  in  the  ears 
may  in  other  cases  be  an  indirect  result  due  to 
high  blood-pressure  caused  by  the  dental  infection. 

Spinal  coed  lesions  have  recently  been  recog- 
nized to  be  sometimes  due  to  infection  arising 
from  the  teeth.  Figaires  35b  and  35c,  are  of  a  pa- 
tient of  Dr.  SoUey's,  with  pernicious  anemia  and 
numbness  and  loss  of  power  in  the  upper  and 
lower  extremities.  She  was  in  a  desperate  con- 
dition with  hemoglobin  of  33  and  becoming  weaker 
every  day.  Dr.  Pearce  Bailey  found  positive  evi- 
dence of  general,  not  merely  lateral,  spinal 
sclerosis  with  symptoms  indicating  a  stage  of  ir- 


64     EOENTGENOGEAPHIC  DIAGNOSIS 

.  ritation  rather  than  destruction  of  the  nerve  fibers 
and  cells  and  with  a  possibility  of  partial  or  com- 
plete cure  if  the  source  of  infection  could  be 
discovered  and  removed.  The  radiographs  showed 
alveolar  abscesses  of  several  teeth.  These  teeth 
were  extracted  and  an  autogenous  vaccine  of  the 
streptococcus  viridans  administered  which  was 
prepared  from  the  pus.  The  same  germ  had  been 
found  in  this  patient's  blood.  There  has  been  im- 
mediate improvement  in  her  general  condition  and 
restoration  of  power  in  the  arms  but  there  is  still 
a  paretic  condition  of  the  lower  extremities. 

Gasteic  IJLCEE.^The  most  surprising  success 
has  been  reported  by  Hartzell,  Henrici  and  Leon- 
ard ^  in  the  treatment  of  gastric  and  duodenal 
ulcer.  Unmistakable  cases  were  cured  so 
promptly  as  to  indicate  a  causative  relation  be- 
tween the  dental  infection  and  the  destructive 
process  in  the  gastric  wall.  We  cannot  tell  which 
of  the  two  factors  is  most  important.  There  is 
the  irritation  from  the  infected  matter  which  is 
constantly  swallowed  with  the  saliva  and  there  is 
the  hematogenous  infection.  The  demonstration 
of  this  easily  discoverable  and  removable  cause 
of  many  cases  of  gastric  and  duodenal  ulcer,  is  a 
fact  of  great  importance.    Consider  the  number  of 

^Eeport  of  the  Minnesota  Division  of  the  Scientific  Founda- 
tion and  Eesearch  Committee,  Journal  of  National  Dental  Asso 
ciation,  November,  1915. 


OF  DENTAL  INFECTION 


65 


these  cases  coming  to  the  roentgenologist  for  diag- 
nosis after  months  or  years  of  pain  and  loss  of 
weight  and  strength.  Also  the  tendency  to  re- 
currence after  medical  treatment  and  the  tendency 
to  produce  adliesions  interfering  with  gastric  and 
intestinal  digestion  and  transit.    Also  the  danger 


Figure  36a.  Figure  36b. 

Figures  36a  and  36b. — Alveolar  Abscesses  and  Pyorrhea  in 

Two  Cases  of  Gastric  Ulcer. 

of  adhesions  following  operative  treatment  and 
the  ever-present  danger  that  a  chronic  ulcer  will 
develop  into  cancer. 

Figure  36a  shows  alveolar  abscesses  of  both 
roots  of  a  lower  molar  tooth  as  one  of  the  lesions 
in  the  case  of  a  lady  who  for  two  years  had  been 
treated  unsuccessfully  for  symptoms  of  gastric 
or  duodenal  ulcer.  After  seeing  the  radiograph 
she  recalled  that  three  years  previously  there  had 
been  pain  about  this  tooth,  the  only  treatment 
having  been  by  counter-irritant  applications. 


66     EOENTGENOGRAPHIC  DIAGNOSIS 

Figure  36b  shows  an  alveolar  abscess  as  one 
of  the  three  dental  foci  of  infection  in  a  lady  who 
had  a  large  hemorrhage  from  the  stomach  with 
temporary  recovery  under  absolute  rest  and  suit- 


FiGURE   37 — Radiograph   to   Determine  Presence   of    Gastric 
Lesion   Requiring  Operation, 

able  diet.  Later  there  were  further  gastric  symp- 
toms and  a  large  six-hour  residue  as  demonstrated 
by  a  radiograph. 

The  dentist  thought  it  wise  to  extract  this  tooth 
and  two  others. 

It  seems  as  if  x-yslj  examination  of  the  stomach 
and  of  the  teeth  should  go  hand  in  hand  in  cases 


Figure   38. — Radiograph   to   Determine   Presexce   oe   Gastric 
OR  Intestinal  Lesion  Requiring  Operation. 


67 


ROENTGENOGRAPHIC  DIAGNOSIS     69 

of  suspected  gastric  or  duodenal  ulcer.  Of  course 
radiographs  of  the  stomach  and  intestine  like  Fig- 
ures 37  and  38  should  be  made  to  exclude  the 
presence  of  a  lesion  requiring  an  abdominal  op- 
eration. 


70     ROENTGENOGRAPHIC  DIAGNOSIS 
CHAPTER  VI 

GENEEAL    CONCLUSIONS 

The  following  general  conclus'ons  are  to  be 
drawn :  A  putrescent  mass  in  the  pulp  chamber  of 
a  tooth  may  exist  for  months  or  years  because  the 
walls  of  the  cavity  cannot  collapse  and  are  incap- 
able of  throwing  out  granulations  and  eventually 
filling  the  cavity  with  healthy  tissue,  like  the 
natural  process  of  curing  an  abscess  in  the  soft 
tissues  of  the  body.  This  putrescent  mass  may 
constantly  poison  the  bony  tissues  surrounding 
the  apical  foramen  sufficiently  to  produce  an  effect 
clearly  recognizable  in  a  radiograph.  This  condi- 
tion may  be  unknown  ta  the  patient  and  sometimes 
not  reveal  itself  to  the  usual  tests  applied  by  the 
dentist.  From  this  long-persisting  source  of  in- 
fection secondary  lesions  and  symptoms  of  the 
gravest  and  most  diversified  character  may  arise. 

The  rr-ray  is  to  be  depended  upon  to  show 
whether  or  not  the  source  of  trouble  is  connected 
with  the  teeth  or  the  pneumatic  sinuses,  and  if  so, 
whether  the  trouble  is  due  to  malposition  and  un- 
natural pressure  or  to  infection.  It  would  be  a 
mistake  to  regard  every  case  as  due  to  the  teeth 
and  proceed  to  sacrifice  the  latter  without  first 
making  a  radiograph  which  may  acquit  them  of 
any  complicity  in  the  matter. 


AUTHOR'S  PUBLICATIONS 

THE   AUTI-IOR'S   OTHER  PUBLICATIONS   UPON 
THE   X-RAY  IN  DENTISTRY 

"Radiotherapy  in  Pyorrhea  Alveolaris,  and  Dental 
Radiography."  Read  before  the  New  York  Institute  of 
Stomatology,  March  1,  1904.  Interstate  Dental  Journ., 
July,  1904,  pp.  495-502. 

"Recent  Work  with  the  A'-ray  and  High  Frequency 
Currents  in  the  Diagnosis  of  Dental  Cases  and  in  the 
Treatment  of  Pyorrhea  and  Cancer."  Read  before  the 
New  York  Odontological  Society,  Oct.  17,  1905.  Dental 
Cosmos,  June,  1906. 

"A"- ray  Examination  of  the  Teeth."  Read  before  the 
New  York  Institute  of  Dental  Technique,  Feb.  28,  1905. 
Dental  Brief,  Philadelphia,  May,  1905;  Vol.  X,  No.  5, 
pp.  257-266. 

"A'-ray  and  High  Frequency  Currents  in  the  Diag- 
nosis and  Treatment  of  Dental  Cases. ' '  National  Dental 
Association,  Buffalo,  1905.  Dental  Cosmos,  1905,  New 
Jersey  State  Dental  Association,  July,  1905. 

' '  Application  of  the  A'-ray  and  High  Frequency  Cur- 
rents in  Dentistry."    Dental  Brief,  Sept.,  1906. 

"Radiographs  Illustrating  the  Topography  of  the 
Pneumatic  Sinuses  of  the  Face."  Read  before  the  Sec- 
tion on  Laryngology  and  Rhinology,  New  York  Academy 
of  Medicine,  Dec.  18,  1907. 

"The  X-ray  and  the  Ultra- Violet  Ray  in  Dentistry." 

Read    before    Philadelphia    Academy    of    Stomatology, 

March  24,  1908. 

71 


72  AUTHOR'S  PUBLICATIONS 

"The  X-ray  and  the  Ultra-Violet  Ray  in  Dental  Diag- 
nosis and  Treatment."  Paper  and  practical  demonstra- 
tion presented  before  the  Northern  Dental  Society,  May 
13,  1909.    New  York  Medical  Journal,  March  19,  1910. 

"A"-ray  Measurement  of  the  Unerupted  Teeth  at  the 
Age  of  Five  or  Six  Years  to  Provide  for  Preliminary 
RegTilation  of  the  Dental  Arch  if  Required."  Annual 
Meeting  of  the  Dental  Society  of  State  of  New  York, 
May  8,  1913. 

' '  X-ray  Measurement  of  the  Unerupted  Teeth  at  the 
Age  of  Five  or  Six  Years  to  Provide  for  Preliminary 
Regulation  of  the  Dental  Arch  if  Required."  Read 
before  the  Eastern  Association  Graduates  of  the  Angle 
School  of  Orthodontia,  5th  Annual  Meeting,  April  23, 
1914.    Harvard  Odontological  Society,  Oct.  15,  1915. 

''X-ray  Prevention  of  Nasal  Diseases ;  X-ray  Examina- 
tion at  the  Age  of  Five  or  Six  Years  as  a  Prophylactic 
against  Spurs  and  Deviations  of  the  Septum  and  Dis- 
orders of  the  Tonsils,  Adenoids,  and  Accessory  Pneu- 
matic Sinuses."  New  York  Medical  Journal,  March  13, 
1915. 

"Medical  Electricity,  Roentgen  Rays  and  Radium." 
W.  B.  Saunders  Co.,  Philadelphia,  1910  and  1915. 

"  Roentgenographic  Diagnosis  of  Dental  Infection  in 
Systemic  Diseases."  Papers  read  before  the  Roentgen 
Ray  Association  of  Greater  New  York,  Jan.  27,  1916, 
The  Bronx  County  Dental  Society,  Feb.  28,  1916,  the 
New  York  State  Dental  Society,  May  13,  1916,  and  the 
Medical  Association  of  Greater  New  York,  May  15,  1916. 


INDEX 


Alveolar  abscess,  10 

cysts  differentiated  from,  31 

fistulous  type  of,  14 

flaring  foramen  differentiated 

from,  35 
impacted   wisdom    tooth    dif- 
ferentiated from,  34 
in  teeth  already  treated,  14 
malocclusion        differentiated 

from,   29 
origin  of,  11 

pulp-stones   differentiat- 
ed from,   29 
symptoms  of,  10 
treatment  of,   10 
dentists',   12 
in  mild  cases,  12 
unerupted  tooth  and,  33 
Anemia,   pernicious,   dental   in- 
fection and,  37 
Arterial  hypertension,   56 
Arthritis,   46 

dental  infections  and,  37 
Autogenous  vaccines  in  systemic 
diseases    due    to    dental 
infection,   39 

Bacteriological    studies    of    the 
mouth,  36 


Cough,  paroxysmal,  56 
Cysts,  31 

dentigerous,   33 

Dental  foci  of  infection  in  sys- 
temic diseases,  a;-ray  ex- 
amination for,  38 
Dental  infections,  10 

bacteriological  studies  of,  36 
lesions  and  symptoms  second- 
ary to,  40 
Dentigerous  cysts,  33 
Duodenal  ulcer,  64 
Dying  nerve,  removal  of,   12 
untreated,  infection  from,  13 

Endocarditis,   46 
Exophthalmic  goitre,  61 
Eye,  diseases  of,  62 

Fistulous  type  of   alveolar  ab- 
scess, 14 
of  pyorrhea  alveolaris,  24 
Flaring  foramen,  35 

Gastric  ulcer,  64 

dental  infections  and,   37 
Goitre,  exophthalmic,  61 


Cardiac  lesions.    See  Heart,  le-       Heart,  lesions  of,  59 

sions  of.  dental  infections  and,  37 

Clinical  studies  of  infections,  37       Hemiplegia,  46 

73 


74 


INDEX 


High-frequency  currents  in 
treatment  of  pyorrhea 
alveolaris,  22 

Impacted  wisdom  tooth,  34 
Infection,   bacteriological   stud- 
ies of  the  mouth  and,  36 
clinical  studies  of,   37 
dental,  10 

foci    of,    in    systemic    dis- 
eases,     a;-ray      examina- 
tion for,   38 
lesions  and   symptoms   sec- 
ondary to,  40 
focus   of,   value   of   a;-ray   in 

revealing,   26 
from  untreated   dying  nerve, 

13 
in   sinuses,   25 

in  teeth    {see  also  Infection, 
dental),  10 
Ipecac      alkaloid      emetine      in 
treatment     of     pyorrhea 
alveolaris,  23 

Malocclusion,   29 
Meningitis,  46 

Myocarditis,  dental  infection 
and,  39 

Nephritis,       dental      infections 

and,  37 
Nerve,  dying,  removal  of,  12 
untreated,    infection    from, 
13 
Neuralgia,  55 

dental  infections  and,  37 
Neurasthenia,    40 
Neuritis,  55 

Paroxysmal  cough,  56 


Pericarditis,     dental     infection 

and,   39 
Pernicious    anemia,    dental    in- 
fections and,  37 
Pleurisy,  46 

Pneumatic      sinuses,      infection 
in,  25 
lesions  and   symptoms  sec- 
ondary to,  40 
value    of    a;-ray    diagnosis 
in,  26 
Pulp-stones,  29 
Pyorrhea  alveolaris,   15 
cases,   24 
causes  of,  17 

from  broken  instrument,  19 
from  extruded  root-filling,  18 
from  retained  root,  19 
from  unerupted  tooth,  17,  24 
in  otherwise  healthy  mouths, 

39 
painfulness  of,  20 
symptoms  of,  15 
treatment  of,  21 
by  dentist,   21 
by  ultra-violet  ray,  22 
by   a;-ray,    21 
high-frequency  currents  in, 

22 
ipecac  alkaloid  emetine  in, 
23 
with  fistulous  opening,  24 
Pyorrheal     pocket,     demonstra- 
tion of,   16 

Eadiographic  diagnosis  of  den- 
tal infection,   26 
in  systemic  diseases,  38 

Eetained  root  a  cause  of  pyor- 
rhea  alveolaris,    19 


INDEX 


75 


Elieuinatism,  use  of  vaccines  in, 
39 

Eiggs'  disease  {see  also  Pyor- 
rhea alveolaris),  15 

Roentgenographic  diagnosis  of 
dental  infection,  conclu- 
sions, 70 

Sciatica,  55 

Sinuses,     pneumatic,     infection 
in,   25 
lesions  and  symptoms  sec- 
ondary  to,   40 
value   of   aj-ray   in   diagno- 
sis of,  26 
Spinal  cord,  lesions  of,  63 
Stomach,  ulcer  of.     See  Gastric 

ulcer. 
Systemic  diseases,  alveolar  ab- 
scess   and    pyorrhea    as 
causes  of,  37 
due  to   dental   infection,   use 
of  vaccines  in   {see  also 
diseases  by  name),  39 
fl;-ray  examination  for  dental 
foci  of  infection  in,  38 

Teeth,   infections   of,   10 

bacteriological    studies    of, 
36 


Teeth,  infections  of,  lesions  and 
symptoms  secondary  to, 
40 
a;-ray  examination  of,  for 
foci  of  infection  in  sys- 
temic diseases,  38 

Tic  douloureaux,  55 

Tinnitus  aurium,  63 

Tuberculosis,  40 


Ulcer,  gastric  and  duodenal,  64 
Ultra-violet    ray    in    treatment 
of  pyorrhea  alveolaris,  22 
Unerupted    tooth,    a    cause    of 
pyorrhea    alveolaris,    17, 
24 
combined    with    alveolar    ab- 
scess,  33 


Vaccines,  use  of,  in  systemic 
diseases  due  to  dental 
infection,   39 

X-ray    examination    for    dental 
foci   of   infection,   26 
in   systemic   diseases,   38 

X-raj  treatment  of  pyorrhea 
alveolaris,  21 


Paul  B.  Hoeber,  67-69  East  59th  St.,  New  York. 


MEDICAL   MONOGRAPHS 

Published  by 
~      PAUL  B.   HOEBER 

67^69  East  59th  St.,  New  York 

This  catalogue  comprises  only  our  own  publications.  It  will 
be  noticed  that  particular  care  has  been  exercised  in  the  selec- 
tion of  Monographs  of  timely  interest. 

We  are  always  glad  to  consider  the  publication  of  new  and 
original  viedical  works.  Correspondence  with  Authors  is 
invited. 

ADAM:     Asthma  and  Its  Eadical  Treatment.     By  James 
Adam,    m.a.,    m.d.,    f.r.c.p.s.      Hamilton.      Dispensary   Aural 
Surgeon,  Glasgow  Royal  Infirmary. 
8vo,  Cloth,  viii+184  Pages,  Illustrated $1.50  net. 

AMERICAN  JOURNAL  OF  ROENTGENOLOGY,  THE. 
Official  Organ  of  the  American  Roentgen  Ray  Society. 
Edited  by  Dr.  P.  M.  Hickey,  Detroit.  Published  Monthly 
(Volume  III,  No.  1  Published  January,  1916)  .$5.00  per  year. 

ARMSTRONG:  I.  K.  Therapy,  with  Special  Reference  to 
Tuberculosis.  By  W.  E.  M.  Armstrong,  m.a.,  m.d.  Dublin. 
Bacteriologist  to  the  Central  London  Ophthalmic  Hospital, 
Late  Assistant  in  the  Inoculation  Department,  St.  Mary's 
Hospital,  Padding,  W. 
8vo,  Cloth,   x-l-93  Pages,  Illustrated $1.50  net. 

BACH:  Ultra- Violet  Light  by  Means  of  the  Alpine  Sun 
Lamp.  By  Hugo  Bach,  m.d.,  Bad  Elster,  Saxony,  Germany. 
Authorized  Translation  from  the  German,  114  Pages,  Illus- 
trated     $1.00    net. 

BIGG:  Indigestion,  Constipation  and  Liver  Disorder.  By 
G.  Sherman  Bigg,  Fellow  of  the  Royal  College  of  Surgeons; 
Fellow  of  the  Royal  Institute  of  Public  Health ;  Late  Surgeon 
Captain,    Army    Medical    Staff;    Surgeon    Allahabad,    India. 

12mo,  Cloth,  viii+168  Pages $1.50  net. 

1 


2  HOEBEB'S  MEDICAL  MONOGBAPHS 

BRAUN  AND  FRIESNER:  Cerebellar  Abscess:  Its  Eti- 
ology, Pathology,  Diagnosis  and  Treatment.  (See  Friesner 
&  Braun) $2.50  net. 

BROCKBANK:  The  Diagnosis  and  Treatment  of  Heart 
Disease.  Practical  Points  for  Students  and  Practitioners. 
By  E.  M.  Brockbank,  m.d.  (Vict.),  e.r.c.p.,  Hon.  Physician, 
Royal  Infirmary,  Manchester,  Clinical  Lecturer  on  Diseases 
of  the  Heart,  Dean  of  Clinical  Instruction,  University  of 
Manchester. 
12mo,  Cloth,  2nd  Edition,  120  Pages,  Illustrated.  .$1.50  net. 

BROWNE :  Religio  Medici,  Letters  to  a  Friend,  etc.,  and 
Christian  Morals.  2nd  Edition,  with  Preface  by  Drs.  Osier 
and  Packard In  Preparation. 

BRUCE :     Lectures  on  Tuberculosis  to  Nurses.     Based  on 
a   course   delivered    to    the   Queen   Victoria   Jubilee    Nurses. 
By  Olliver  Bruce,  M.R.c.s.,  l.r.c.p.,  Joint  Tuberculosis  Officer, 
County  of  Essex. 
12mo,  Cloth,  124  Pages,  Illustrated $1.00  net. 

BRUNTON:     Therapeutics    of    the    Circulation.     By    Sir 
Lauder     Brunton,     m.d.,     d.sc,    ll.d.     Edin.,    ll.d.     Aberd., 
F.R.C.P.,    F.R.s.      Consulting   Physician   to   St.   Bartholomew's 
Hospital.     Second   Edition,   Entirely   Revised. 
Cloth,   xxiv-|-536  Pages,   110   Illustrations $2.50   net. 

BULKLEY:  Compendium  of  Diseases  of  the  Skin.  Based 
on  an  analysis  of  thirty  thousand  consecutive  cases.  With 
a  Therapeutic  Formulary,  by  L.  Duncan  Bulkley,  a.m., 
M.D.  Physician  to  the  New  York  Skin  and  Cancer  Hospital; 
Consulting  Physician  to  the  New  York  Hospital. 
8vo,  Cloth,  xviii-1-286  Pages $2.00  net. 

BULKLEY:     Cancer:     Its  Cause  and  Treatment.     By  L. 
Duncan  Bulkley. 
8vo,  Cloth,  224  Pages $1.50  net. 

BULKLEY:     Diet  and  Hygiene  in  Diseases  of  the  Skin. 
By  L.  Duncan  Bulkley. 
8vo,  Cloth,  xvi4-194  Pages $2.00  net. 

BULKLEY:  The  Influence  of  the  Menstrual  Function 
on  Certain  Diseases  of  the  Skin.  By  L.  Duncan  Bulkley. 
12mo,  Cloth,  108  Pages $1.50  net. 

BULKLEY:     The  Relations  of  Diseases  op  the  Skin  to 
Internal  Disorders  :  With  Observations  on  Diet,  Hygiene 
and  General  Therapeutics.     By  L.  Duncan  Bulkley. 
12mo,   Cloth,   175   Pages $1.50  net. 

BULKLEY:  Principles  and  Application  of  Local  Treat- 
ment in  Diseases  op  the  Skin.  By  L.  Duncan  Bulkley. 
12mo,   Cloth,   130   Pages $1.50  net. 


IIOEBER'S  MEDICAL  MONOGRAPHS  3 

CAUTLEY:     The  Diseases  op  Infants  and  Children.     By 
Edmund  Cautley,  m.d.  Cantab.,  p.r.c.p.  Lond.     Senior  Physi- 
cian  to   the   Belgrave   Hospital   for   Cliildren;    Physician   to 
the  Metropolitan  Hospital;   etc. 
Large  8vo,  Cloth,  1042  Pages $7.00  net. 

CLARKE:  Problems  in  the  Accommodation  and  Refraction 
OP  THE  Eye,  a  Brief  Review  op  the  Work  op  Bonders, 
and  the  Progress  Made  During  the  Last  Fifty  Years.  By 
Ernest  Clarke,  m.d.,  b.s.,  p.r.c.s.  Senior  Surgeon  to  tlie 
Central  London  Ophthalmic  Hospital,  Consulting  Ophthalmic 
Surgeon  to  the  Miller  General  Hospital. 
8vo,  Boards,  110  Pages $1.00  net. 

COOKE:  The  Position  op  the  X-Rays  in  the  Diagnosis 
and  Prognosis  op  Pulmonary  Tuberculosis.  By  W.  E. 
Cooke,  M.B.,  M.R.C.P.E.,  d.p.h.  (Lond.),  Medical  Superin- 
tendent, Ochil  Hills  Sanatorium  and  Gfbppins  Green  Industrial 
Sanatorium.     8vo,  Cloth,  Illustrated $1.50  net. 

COOPER:  Pathological  Inebriety.  Its  Causation  and 
Treatment.  By  J.  W.  Astley  Cooper.  Medical  Superin- 
tendent and  Licensee  of  Ghyllwood  Sanatorium  near  Cocker- 
mouth,  Cumberland.  With  Introduction  by  Sir  David  Fer- 
rier,  m.d.,  p.e.s.    12mo,  Cloth,  xvi+151  Pages $1.50  net. 

COOPER:     The    Sexual    Disabilities    op    Man,    and    Their 
Treatment.     By  Arthur  Cooper.     Consulting  Surgeon  to  the 
Westminster  General  Dispensary;    Formerly  Surgeon   to  the 
Male  Lock  Hospital,  London. 
2nd  Edition,  12mo,  Cloth,  viii+204  Pages $2.00  net. 

CORBETT-SMITH :  The  Problem  op  the  Nations.  A  Study 
in  the  Causes,  Symptoms  and  Effects  of  Sexual  Disease,  and 
the  Education  of  the  Individual  Therein.  By  A.  Corbett- 
Smith,  Editor  of  The  Journal  of  State  Medicine;  Lec- 
turer in  Public  Health  Law  at  the  Royal  Institute  of  Public 
Health.    Large  8vo,  Cloth,  xii+107  Pages $1.00  net. 

CORNET:     Acute  General  Miliary  Tuberculosis.     By  Pro- 
fessor  Dr.   G.   Cornet,   Berlin   and   Reichenhall.      Translated 
by  F.  S.   Tinker,  b.a.,  m.b.,  etc. 
8vo,   Cloth,  viii-l-107  Pages $1.50  net. 

CROOKSHANK:     Flatulence  and  Shock.    By  F.  G.  Crook- 
shank,  M.D.  Lond.,  m.r.c.p.    Physician  (Out  Patients)  Hamp- 
stead  General  and  N.  W.  Lond.  Hospital ;  Assistant  Physician 
The  Belgrave   Hospital  for   Children   S.   W. 
Svo,  Cloth,  iv+47  Pages $1.00  net. 

DAVIDSON:  Localization  by  X-Rays  and  Stereoscopt. 
By  Sir  James  Mackenzie  Davidson,  m.b.,  cm.  Aberd.  Con- 
sulting   Medical    Officer,    Roentgen   Ray    Department,    Royal 


4  HOEBEB'S  MEDICAL  MONOGRAPHS 

London  Ophthalmic  Hospital,  and  X-Eay  Department,  Char- 
ing Cross  Hospital;  Fellow,  Physical  Society;  President, 
Eadiology  Section,  Seventeenth  International  Congress  of 
Medicine.  8vo,  Cloth,  72  Pages,  Plates  and  58  Stereoscopic 
Figures    $3.00  net. 

DELOEME:  War  Surgery.  By  Edmond  Delorme,  General 
Medical  Inspector  of  the  French  Army.  Translated  by  D. 
De  Meric,  Surgeon  to  In-Patients,  French  Hospital,  London. 
12mo,  Cloth,  Illustrated,  248  Pages $1.50  net. 

EDEIDGE-GEEEN:  The  Hunterian  Lectures  on  Colour- 
Vision  AND  Colour  Blindness.  Delivered  before  the  Eoyal 
College  of  Surgeons  of  England  on  February  1st  and  3rd, 
1911.  By  Professor  F.  W.  Edridge-Green,  m.d.  Durh., 
F.R.c.s.  England.  Beit  Medical  Eesearch  Fellow. 
8vo,  Cloth,  x-f  76  Pages $1.50  net. 

£;iIELICH:  Experimental  Eesearches  on  Specific  Thera- 
peutics. By  Prof.  Paul  Ehrlich,  m.d.,  d.sc.  Oxon.  Director 
of  the  Konigliches  Institut  fiir  Experimentelle  Therapie, 
Frankfort.  The  Harben  Lectures  for  1907  of  The  Eoyal 
Institute  of  Public  Health. 
16mo,  Cloth,  x-f  95  Pages $1.00  net. 

EINHOEN:      Lectures    on    Dietetics.      By    Max    Einhorn, 
Professor  of  Medicine  at  the  New  York  Post-Graduate  Med- 
ical   School    and    Hospital    and    Visiting    Physician    to    the 
German  Hospital,  New  York. 
12mo,  Cloth,  xvi-(-156  Pages $1.00  net. 

ELLIOT:     Sclero-Corneal     Trephining  in   the  Operative 
Treatment  of  Glaucoma.     By  Eobert  Henry  Elliot,  m.d., 
B.s.    Lond.,    D.sc.    Edin.,    f.r.c.s.    Eng.,    etc.      Lieut.    Colonel 
i.M.s.     Second   Edition. 
8vo,   Cloth,   135   Pages,   33   Illustrations $3.00  net. 

EMEEY :  Immunity  and  Specific  Therapy.  By  Wm.  D  'Este 
Emery,  m.d.,  b.sc.  Lond.  Clinical  Pathologist  to  King's 
College  Hospital  and  Pathologist  to  the  Children's  Hospital, 
Paddington  Green;  formerly  Assistant  Bacteriologist  to  the 
Eoyal  College  of  Physicians  and  Surgeons,  and  some  time 
Lecturer  on  Pathology  and  Bacteriology  in  the  University 
of   Birmingham. 

8vo,   Cloth,  448   Pages,  with  2  Illustrations $3.50  net. 

adopted  by  the  u.  s.  army. 

FEIESNEE  AND  BEAUN:  Cerebellar  Abscess;  Its  Eti- 
ology, Pathology,  Diagnosis  and  Treatment.  By  Isidore 
Friesner,  m.d.,  f.a.c.s..  Adjunct  Professor  of  Otology  and 
Assistant  Aural  Surgeon,  Manhattan  Eye,  Ear  and  Throat 
Hospital  and  Post.  Graduate  Medical  School,  and  Alfred 
Braun,   m.d.,   f.a.c.s.,   Assistant   Aural   Surgeon,   Manhattan 


HOEBEE'S  MEDICAL  MONOGBAPnS  5 

Eye,  Ear  and  Throat  Hospital,  Adjunct  Professor  of 
Laryngology,  New  York  Polyclinic  Hospital  and  Medical 
School  and  Adjunct  Otologist,  Mt.  Sinai  Hospital.  8vo,  Cloth, 
about  200  Pages,  10  Plates,  16  Illustrations $2.50  net. 

GHON:     The    Primary    Lung    Focus    of    Tuberculosis    in 
Children.     By   Anton   Ghon,   m.d.,   English   Translation   by 
D.  Barty  King,  m.a.,  m.d.  Edin.,  m.r.c.p..  Assistant  Physician 
to  the  Eoyal  Hospital  for  Diseases  of  the  Chest. 
196  Pages,  72  Text  Figures  and  2  Plates $.3.7.5  net. 

GILES:  Anatomy  and  Physiology  of  the  Female  Genera- 
tive Organs  and  of  Pregnancy.  By  Arthur  E.  Giles,  m.d., 
B.sc.  Lond.,  m.r.c.p.  Lond.;  F.R.C.S.  Ed.  Gynecologist  to  the 
Prince  of  Wales  General  Hospital,  Tottenham,  and  Surgeon 
to  the  Chelsea  Hospital  for  Women. 
Large  8vo,  24  Pages,  with  Mannikin $1..50  net. 

GOULSTON:  Cane  Sugar  and  Heart  Disease.  By  Arthur 
Goulston,  M.A.,  M.D.  Cantab.  Hunterian  Society's  Medallist, 
1912.     8vo,  Cloth,  107  Pages $2.00  net. 

GREEFF:  Guide  to  the  Microscopic  Examination  of  the 
Eye.  By  Professor  E.  Greeff.  Director  of  the  University 
Ophthalmic  Clinique  in  the  Eoyal  Charity  Hospital,  Berlin. 
With  the  co-operation  of  Professor  Stock  and  Professor 
Wintersteiner.  Translated  from  the  third  German  Edition 
by  Hugh  Walker,  m.d.,  m.b.,  cm.  Ophthalmic  Surgeon  to 
the  Victoria  Infirmary,  Glasgow. 
Large  8vo,  Cloth,  86  Pages,  Illustrated $2.00  net. 

HARRIS:  Lectures  on  Medical  Electricity  to  Nurses. 
An  Illustrated  Manual  by  J.  Delpratt  Harris,  m.d.  Durh., 
M.R.c.s.  Senior  Surgeon  and  Honorary  Medical  Officer  in 
charge  of  the  Electrical  Department,  Eoyal  Devon  Hosp. 
12mo,  Cloth,  88  Pages,  Illustrated $1.00  net. 

HELLMAN:  Amnesia  and  Analgesia  in  Parturition — 
Twilight  Sleep.  By  Alfred  M.  Hellman,  b.a.,  m.d.,  f.a.c.s. 
8vo,  Cloth,  with  Charts,  200  Pages $1.50  net. 

HEWATT:     The    Examination    of    the    Urine,    and    Other 
Clinical  Side  Eoom  Methods.     By  Andrew  Fergus  Hewatt, 
M.B.,  CH.B.,   m.r.c.p.  Edin. 
16mo,  5th  Edition,  Numerous  Illustrations $  .75  net. 

HOFMANN-GARSON:  Remedial  Gymnastics  for  Heart 
Affections.  Used  at  Bad-Nauheim.  Being  a  Translation 
of  ' '  Die  Gymnastik  der  Herzleidenden ' '  von  Dr.  Med.  Julius 
Hofmann  und  Dr.  Med.  Ludwig  Pohlman.  Berlin  and  Bad- 
Nauheim.  By  John  George  Garson,  m.d.  Edin.,  etc.  Physi- 
cian to  the  Sanatoria  and  Bad-Nauheim,  Eversley,  Hants. 
With  51  Full-page  Illustrations  and  Diagrams.  Large  8vo, 
Cloth,  xvi-l-128  Pages $2.00  net. 


6  HOEBEB'S  MEDICAL  MON 0GB APRS 

HOWARD :     The   Therapeutic  Value  of  the  Potato.     By 
Heaton   C.   Howard,   l.r.c.p.  Lond.,   m.r.c.s.   Eng. 
8vo,   Paper,    vi-|-31    Pages,   Illustrated 50c 

JELLETT:  A  Short  Practice  op  Midwifery  for  Nurses. 
Embodying  the  treatment  adopted  in  the  Rotunda  Hospital, 
Dublin.  By  Henry  Jellett,  b.a.,  m.d.  (Dublin  University), 
F.R.C.P.I.,  Master  Rotunda  Hospital;  Extern  Examiner  in 
Midwifery  and  Gynecology,  Victoria  University,  Manchester; 
Late  King's  Professor  of  Midwifery;  University  of  Dublin. 
With  Six  Plates  and  169  Illustrations  in  the  Text,  also 
an  Appendix,  a  Glossary  of  Medical  Terms,  and  the  Regu- 
lations of  the  Central  Midwives  Board. 
12mo,   Cloth,  xvi-^508  Pages $2.50  net. 

KENWOOD :  Public  Health  Laboratory  Work.  By  Henry 
R.  Kenwood,  m.b.,  f.r.s.  Edin.,  p.p.h.,  f.c.s.,  Chadwick. 
Professor  of  Hygiene  and  Public  Health,  University  of  Lon- 
don; Medical  Oflficer  of  Health  and  Public  Analyst  for  the 
Metropolitan  Borough  of  Stoke  Newington ;  Examiner  in 
Public  Health  to  the  Royal  College  of  Physicians  and 
Surgeons,  London,  etc. 
6th  Edition,  8vo,  Cloth,  418  Pages,  Illustrated $4.00  net. 

KERLEY:     What  Every  Mother  Should  Know  About  Her 
Infants  and  Young  Children.    By  Charles  Gilmore  Kerley, 
M.D.     Professor   of   Diseases   of   Children,   N.   Y.   Polyclinic 
Medical    School    and    Hospital. 
8vo,  Paper,   107   Pages 35c  net. 

KETTLE:  The  Pathology  op  Tumors.  By  E.  H.  Kettle, 
M.D.,  B.S.,  Assistant  Pathologist,  St.  Mary's  Hospital,  and 
Assistant  Lecturer  on  Pathology,  St.  Mary's  Hospital  Med- 
ical School.     About  240  Pages,  126  Illustrations.  .  .$3.00  net. 

LEWERS:  A  Practical  Textbook  op  the  Diseases  of 
Women.  By  Arthur  H.  N.  Lewers,  m.d.  Lond.  Senior 
Obstetric  Physician  to  the  London  Hospital;  Late  Examiner 
in  Obstetric  Medicine  at  the  University  of  London;  Univer- 
sity Scholar  &  Gold  Medallist  in  Obstetric  Medicine,  London 
University,  etc. 

With  258  Illustrations,  13  Colored  Plates,  5  Plates  in  Black 
and  ^Vhite.    7th  Edition,  8vo,  Cloth,  xii+540  Pages. $4.00  net. 

LEWIS:  Clinical  Disorders  op  the  Heart  Beat.  A  Hand- 
book for  Practitioners  and  Students.  By  Thomas  Lewis,  m.d., 
D.sc,  f.r.c.p.  Assistant  Physician  and  Lecturer  in  Cardiac 
Pathology,  University  College  Hospital  Medical  School, 
Physician  to  Out-Patients,  City  of  London  Hospital  for 
Diseases  of  the  Chest. 
3rd  Ed.,  8vo,  Cloth,  116  Pages,  54  Illustrations.  .$2.00  net. 


HOEBEE'S  MEDICAL  MONOGRAPHS  7 

LEWIS:     Lectures  on  the  Heart.     Comprising  the  Herter 
Lectures   (Baltimore),  a  Harvey  Lecture    (New  York),  and 
an  Atklress  to  the  Faculty  of  Medicine  at  McGill  University 
(Montreal).     By  Thomas  Lewis. 
124  Pages,  with   83   Illustrations $2.00  net. 

LEWIS:  Clinical  Electrocardiography.  By  Thomas  Lewis, 
8vo,   Cloth,   120   Pages,   with   Charts $2.00  net. 

LEWIS:  The  Mechanism  OF  THE  Heart  Beat.  With  Special 
Eeference  to  Its  Clinical  Pathology.  By  Thomas  Lewis. 
Large  8vo,  Cloth,  29.5  Pages,  227  Illus $7.00  net. 

McCLUEE:  A  Handbook  of  Fevers.  By  J.  Campbell  Mc- 
Clure,  M.D.,  Glasgow.  Physician  to  Out-Patients,  The 
French  Hospital,  and  Physician  to  the  Margaret  Street 
Hospital  for  Consumption  and  Diseases  of  the  Chest,  London. 
8vo,  Cloth,  470  Pages,  with  Charts $3.50  net. 

McCRUDDEN:    The  Chemistry,  Physiology  and  Pathology 
OF  Uric  Acid,  and  the  Physiologically  Important  Purin 
Bodies.     With  a  Discussion  of  the  Metabolism  in  Gout.     By 
Francis   H.    McCrudden. 
12mo,  Paper,  318  Pages $2.00  net. 

McKISACK:    Systematic    Case  Taking.     A  Practical  Guide 
to   the   Examination   and   Recording   of   Medical   Cases.     By 
Henry  Lawrence  McKisack,   m.d.,  m.r.c.p.   Lond.     Physician 
to  the  Royal  Victoria  Hospital,  Belfast. 
12mo,  Cloth,  166  Pages $1.50  net. 

MACKENZIE:     Symptoms  and  Their  Interpretations.     By 
James  Mackenzie,  m.d.,  ll.d.  Aber.  and  Edin.     Lecturer  on 
Cardiac   Research,   London    Hospital. 
8vo,  Cloth,  Illustrated,  xxii4-304  Pages $3.00  net 

MACMICHAEL:  The  Gold-Headed  Cane.  By  William  Mac 
michael.  Reprinted  from  the  2nd  Edition.  With  a  Preface 
by  Sir  William  Osier  and  an  Introduction  by  Dr.  Francis  R 
Packard.  Printed  from  large  Scotch  type  on  a  special  heavy- 
weight paper,  5%  by  7%  inches,  bound  in  blue  Italian  hand 
made  paper,  with  parchment  back,  gilt  top,  square  back 
and  gold  stamping  on  back  and  side $3.00  net 

MAGILL:     Notes  on  Galvanism  and  Faradism.     By  E.  M 
Magill,  M.B.,  B.s.  Lond.,  R.c.s.i.   (Hons.) 
12mo,   Cloth,   220   Pages,   07   Illustrations $1.50   net 

MARTINDALE    and    WESTCOTT:     "Salvarsan"    "606" 
(Dioxy-Diamino-Arsenobenzol),  Its  Chemistry,  Pharmacy 
AND  Therapeutics.     By  W.  Harrison  Martindale,  ph.d.  Mar- 
burg,  F.C.S.,   and  W.   Wynn  Westcott,   m.b. 
8vo,  Cloth,  xvi4-76  Pages $1.50  net. 


8  HOEBER'S  MEDICAL  MONOGBAPES 

MINETT :     Diagnosis  of  Bacteria  and  Blood  Parasites.    By 

E.  P.  Minett,  m.d.,  d.p.h.,  d.t.m.  and  H.,  m.r.o.s.,  l.r.c.p. 
Assistant  Government  Medical  Officer  of  Health  and  Bacteri- 
ologist British  Guiana. 

12mo,  Cloth,  viii+80  Pages $1.00  net. 

MOTT :    Nature  and  Nurture  in  Mental  Development.    By 

F.  W.  Mott,  M.D.,  F.R.S.,  F.R.c.P.     Pathologist  to  the  London 
County    Asylums,    Consulting    Physician    to    Charing    Cross 
Hospital  and  the  Queen  Alexandra  Military  Hospital. 
12mo,   Cloth,    151    Pages,   with   Diagrams $1.50   net. 

MUEEELL:  What  To  Do  in  Cases  of  Poisoning.  By  Wil- 
liam Murrell,  m.d.,  f.r.c.p.  Senior  Physician  to  the  West- 
minster Hospital;  Lecturer  on  Clinical  Medicine  and  Joint 
Lecturer  on  the  Principles  and  Practice  of  Medicine;  Late 
Examiner  in  the  Universities  of  Edinburgh,  Glasgow  and 
Aberdeen,  and  to  the  Eoyal  College  of  Physicians. 
11th  Edition,  16mo,  Cloth,  283  Pages $1.00  net. 

OLIVEE :  Lead  Poisoning  :  From  the  Industrial,  Medical 
and  Social  Point  of  View.  Lectures  Delivered  at  the  Eoyal 
Institute  of  Public  Health.  By  Sir  Thomas  Oliver,  M.A.,  m.d., 
F.R.c.P.  Consulting  Physician,  Eoyal  Victoria  Infirmary,  and 
Professor  of  the  Principles  and  Practice  of  Medicine,  Uni- 

•  versity  of  Durham  College  of  Medicine,  Newcastle-upon-Tyne, 
Late  Medical  Expert,  Dangerous  Trades  Committee;  Home 
Office.     Large  12mo,  Cloth,  294  Pages $2.00  net. 

OSLEE:  Two  Essays.  By  Sir  William  Osier,  m.d.  Eegius 
Professor  of  Medicine  at  Oxford. 

Vol.  1.    A  Way  of  Life.     An  Address  to  Yale  Students, 
Sunday     Evening,     April     20th,     1913.        16mo,     Cloth,     61 

Pages 50c  net. 

Vol.    2.     Man's   Eedemption   of   Man.     A   Lay   Sermon, 
McEwan   Hall,   Edinburgh,   Sunday,   July   2d,    1910.      16mo, 

Cloth,  63  Pages 50c  net. 

The  Set  Neatly  Bound  and  Boxed $1.00  net. 

(A  handsome  presentation  set.) 

OTT:  Fever,  Its  Thermotaxis  and  Metabolism.  By  Isaac 
Ott,  A.M.,  M.B.  Professor  of  Physiology  in  the  Medico- 
Chirurgical  College  of  Philadelphia;  Ex-Fellow  in  Biology 
Johns  Hopkins  University;  Consulting  Neurologist,  Norris- 
town  Asylum,  Penna. ;  Ex-President  of  American  Neuro- 
logical Association,  etc. 
12mo,  Cloth,  168  Pages,  Illustrated $1.50  net. 

PAGET:  For  and  Against  Experiments  on  Animals.  Evi- 
dence before  the  Eoyal  Commission  of  Vivisection.  By 
Stephen   Paget,   f.r.c.s.     Hon.   Secretary  Eeseareh   Defence 


HOEBEB'S  MEDICAL  MONOGRAPHS  9 

Society.     With  an  Intro<3uction  by  The  Eight  Hon.  The  Earl 

of  Cromer,  o.M.,  g.c.m.g.,  g.c.b. 

8vo,  Cloth,  Illustrated,  xii-f-344  Pages $1.50  net. 

PEGLER:  Map  Scheme  of  the  Sensoey  Distribution  of 
THE  Fifth  Nerve  (Trigeminus)  with  Its  Ganglia  and 
Connections.  By  L.  Hemington  Pegler,  m.d.,  m.e.c.s.  Senior 
Surgeon,  Metropolitan  Ear,  Nose  and  Throat  Hospital,  etc. 

Mounted  on  Rollers,  4t't.  1  in.  x.  4  ft.  8  in $7.00  net. 

Folded   in   Cloth   Binder $8.00  net. 

RAWLING:  Landmarks  and  Surface  Markings  of  the 
Human  Body.  By  L.  Bathe  Rawling,  m.b.,  b.c.  (Cant.), 
F.R.c.s.  (Lond.)  Surgeon  with  Charge  of  Out-Patients,  Late 
Senior  Demonstrator  of  Anatomy  at  St.  Bartholomew's  Hos- 
pital; Late  Assistant-Surgeon  to  the  German  Hospital, 
Dalston;  Late  Hunterian  Professor  Royal  College  of 
Surgeons,  England,  etc. 
5th  Ed.,  8vo,  Cloth,  31  Plates,  xii4-96  Pages  of  Text. $2.00  net. 

RITCHIE :  Auricular  Flutter.  By  William  Thomas  Ritchie, 
M.D.,  F.R.C.P.E.,  F.R.s.E.  Physician  to  the  Royal  Infirmary; 
Lecturer  on  the  Practice  of  Medicine,  School  of  Medicine 
of  the  Royal  Colleges;  Lecturer  on  Clinical  Medicine  in  the 
University  of  Edinburgh.  Large  8vo,  Cloth,  xii+144  Pages, 
21  Plates,  107  Illustrations $3.50  net. 

von    ruck    and    von    RUCK:     Studies    in    Immunization 
AGAINST    Tuberculosis.      By    Karl    von    Ruck,    m.d.,    and 
Silvio  von  Ruck^  m.d. 
8vo,  Cloth,  about  440  Pages $3.50  net. 

RUTHERFORD:  The  Ileo-C^cal  Valve.  By  A.  H.  Ruther- 
ford, M.D.  Edin.  8vo,  Cloth,  63  Pages  of  Text,  23  Full  Page 
Plates,  3  of  Which  Are  Colored $2.25  net. 

SAALFELD  :  Lectures  on  Cosmetic  Treatment.  A  Manual 
for  Practitioners.  By  Dr.  Edmund  Saalfeld  of  Berlin. 
Translated  by  J.  F.  Dally,  m.a.,  m.d.,  b.c.  Cantab., 
M.R.c.p.  Lond.  Physician  to  the  St  Marylebone  General 
Dispensary.  With  an  Introduction  and  Notes  by  P.  S.  Abra- 
ham, M.A.,  M.D.,  B.sc,  F.R.C.S.I.,  Surgeon  for,  and  Lecturer 
on.  Diseases  of  the  Skin,  West  London  Hospital  and  College. 
Late  Surgeon  to  the  Skin  Hospital,  Blaekfriars. 
12mo,  Cloth,  xii-|-186  Pages,  Illustrated $1.75  net. 

SCHOOL  OF  SALERNO,  THE:  New  Edition,  Edited  by 
Drs.  Osier  and  Packard In  Preparation 

SCOTT :  Modern  Medicine  and  Some  Modern  Remedies.  By 
Thomas  Bodley  Scott,  with  a  Preface  by  Sir  Lauder  Brunton. 
8vo $1.50   net. 


10  BOBBER'S  MEDICAL  MONOGRAPBS 

SCOTT:     The   Eoad   to   a    Healthy    Old   Age.      Essays   by 
Thomas  Bodley  Scott,  m.d. 
12mo,  Cloth,  104  Pages $1.00  net. 

SENATOK  and  KAMINEE:  Marriage  and  Disease,  Being 
an  Abridged  Edition  of  ' '  Health  and  Disease  in  Relation  to 
Marriage  and  the  Married  State."  By  Professor  H.  Senator 
and  Dr.  S.  Kaminer.  Translated  from  the  German  by  J. 
Dulberg,  m.d. 
8vo,  Cloth,  452  Pages '. .'$2.50  net. 

SMITH:  Some  Common  Eemedies,  and  Their  Use  in  Prac- 
tice. By  Eustace  Smith,  m.d.  Fellow  of  the  Eoyal  College 
of  Physicians;  Senior  Physician  to  the  East  London  Hospital 
for  Children;  Consulting  Physician  to  the  Victoria  Park 
Hospital  for  Diseases  of  the  Chest. 
8vo,  Cloth,  viii4-112  Pages $1.25  net. 

SQUIER  and  BUGBEE :  Manual  of  Cystoscopy.  By  J. 
Bently  Squier,  m.d.  Professor  of  Genito-Urinary  Surgery, 
New  York  Post-Graduate  Medical  School  and  Hospital,  and 
Henry  G.  Bugbee,  m.d. 

8vo,  Flex.  Leather,  xiv+117  Pages,  26  Colored  Plates  $3.00  net. 
adopted  by  the  u.  s.  army. 

STAEK:  The  Growth  and  Development  of  the  Baby.  A 
tabular  chart,  giving  the  result  of  personal  observation,  veri- 
fied by  authoritative  data,  as  to  development,  weight,  height, 
etc.,  during  the  first  seven  years.  By  Morris  Stark,  m.a.,  b.s., 
m.d.  Instructor  of  Pediatrics,  New  York  Post-Graduate 
Medical  School,  etc. 
Heavy  Paper,   20   by   25   inches 50c   net. 

STEPHENSON:     Eye-Strain   in    Every-day   Practice.     By 
Sidney  Stephenson,  m.b.,  cm.  Edin.,  d.o.  Oxon.,  f.r.c.s.  Edin. 
Ophthalmic  Surgeon  to  the  Queen's  Hospital  for  Children; 
Editor  of  the  Ophthalmoscope. 
8vo,  Cloth,  x-(-139  Pages $1.50  net. 

STEPHENSON:     A   Eeview   of   Hormone   Therapy.     1913. 

8vo,  Cloth,  viii+170  Pages $1.00  net. 

Bound   and   interleaved   edition   of   the   famous   * '  Hormone 
Number"  of  the  Prescriber   (Edinburgh). 

SWIETOCHOWSKI:      Mechano-Therapeutics    in    General 
Practice.    By  G.  de  Swietochowski,  m.d.,  m.r.c.s.    Fellow  of 
the  Eoyal  Society  of  Medicine;  Clinical  Assistant,  Electrical 
and  Massage  Department,  King 's  College  Hosp. 
12mo,  Cloth,  xiv-4-141  Pages,  31  Illustrations $1.50  net. 

TOUSEY:  Eoentgenographic  Diagnosis  of  Dental  Infec- 
tion IN  Systemic  Diseases.  By  Sinclair  Tousey,  a.m.,  m.d. 
About  72  Pages  and  70  Illustrations $1.50  net. 


EOEBER'S  MEDICAL  MONOGRAPHS  11 

TURNER  and  PORTER:  The  Skiagraphy  of  the  Acces- 
sory Nasal  Sinuses.  By  A.  Logan  Turner,  m.d.,  f.r.c.s.e., 
F.R.s.E.  Surgeon  to  the  Ear  and  Throat  Department,  the 
Royal  Infirmary,  Edinburgh,  and  W.  G.  Porter,  m.b.,  b.sc, 
F.R.C.S.E.  Surgeon  to  Eye  and  Throat  Infirmary,  Edinburgh. 
Quarto,  Cloth,  45  Pages  of  Text,  .39  Plates $4..50  net. 

WANKLYN:  How  to  Diagnose  Smallpox.  A  Guide  for 
General.  Practitioners,  Post-Graduate  Students,  and  Others. 
By  W.  McC.  Wanklyn,  b.a.  Cantab.,  m.r.c.s.,  l.r.c.p.,  d.p.h. 
Assistant  Medical  Officer  of  the  London  County  Council  and 
formerly  Medical  Superintendent  of  the  River  Ambulance 
Service  (Small-pox). 
8vo,  Cloth,  102  Pages,  Illustrated $1.50  net. 

WATSON:  Gonorrhoea  and  Its  Complications  in  the  Male 
AND  Female.  By  David  Watson,  m.b.,  cm.,  Surgeon,  Glasgow 
Lock  Hospital  Dispensary,  Surgeon  for  Venereal  Diseases, 
Glasgow  Royal  Infirmary,  etc.,  etc.  8vo,  Cloth,  375  Pages, 
72  Illustrations,  12  Plates,  Some  Colored $3.75  net. 

WHITE :     The  Pathology  of  Growth.  Tumours.  By  Charles 
Powell    White,    M.c,    p.r.c.s.      Director,    Pilkington    Cancer 
Research  Fund,   Pathologist  Christie   Hospital,  Special  Lec- 
turer in  Pathology,  University  of  Manchester. 
8vo,  Cloth,  xvi4-235  Pages,  Illustrated $3.50  net. 

WHITE:  Occupational  Affections  of  the  Skin.  A  brief 
account  of  the  trade  Processes  and  Agents  which  give  rise 
to  them.  By  P.  Prosser  White,  m.d.,  Ed.,  m.r.c.s.  Lond.  Life 
Vice-President,  Senior  Physician  and  Dermatologist,  Royal 
Albert  Edward  Infirmary,  Wigan,  Vice-President,  Assoc. 
Certif.  Fact.  Surgeon;  Life  Fellow,  Lond.  Dermat.  Society. 
8vo,  Cloth,   165  Pages $2.00  net. 

WICKHAM  and  DEGRAIS:  Radium.  As  employed  in  the 
treatment  of  Cancer,  Angiomata,  Keloids,  Local  Tuberculosis 
and  other  affections.  By  Louis  Wickham,  m.v.o.  Medecin 
de  St.  Lazare;  Ex-Chef  de  Clinique  a  L'Hopital  St. 
Louis,  and  Paul  Degrais,  Ex-Chef  de  Laboratoire  a  L  'Hopital 
St,  Louis.  Chefs  de  service  au  Laboratoire  Biologique  du 
Radium;  Laureats  de  L'Academie  de  Medecine. 
8vo,  Cloth,  53  Illustrations,  viii-|-lll  Pages $1.25  net. 

WRENCH :     The  Healthy  Marriage.    A  Medical  and  Psycho- 
logical Guide  for  Wives.     By  G.  T.  Wrench,  m.d,,  b.s.  Lond., 
Past  Assistant  Master  of  the  Rotunda  Hospital,  Dublin. 
8vo,    Cloth,    x-f300   Pages $1.50   net. 

WRIGHT:     The  Unexpurgated  Case  against  Woman  Suf- 
frage.    By  Sir  Almroth  E.  Wright,  m.d.,  f.r.s. 
8vo,  Cloth,  xii-|-188  Pages $1.00  net. 


12  HOEBEB'S  MEDICAL  MONOGBAPHS 

WEIGHT :  On  Pharmaco-Therapy  and  Preventive  Inocu- 
lation; Applied  to  Pneumonia  in  the  African  Native,  with 
a  Discourse  on  the  Logical  Methods  Which  Ought  to  Be 
Employed  in  the  Evaluation  of  Therapeutic  Agents.  By 
Sir  Almroth  E.  Wright,  M.D.,  F.R.s. 
8vo,  Cloth,   124  Pages ; $2.00  net. 

Complete  catalogue  and  descriptive  circulars  will  be  sent  on 
request. 


RK270 


T64 


Tousey 

Roentgenograph! 0  diagnosis  of  den- 
tal infeotion  in  systemio  diseases. 


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